Alcoholism is a disease that poses many threats to health. In the United States in the year 2006, 2.5 million people out of the 22.6 million people identified as having a substance abuse problem, received treatment for alcoholism. 1 Despite these alarming statistics nurses lack knowledge and understanding of Alcoholics Anonymous. Alcoholics Anonymous (AA) has been identified as the most effective form of treatment for alcoholism. Increasing nurses’ knowledge and understanding of how AA works as a program of recovery is imperative to improve patient care, education and outcomes, as well as nurses’ confidence and competence in working with this patient population.
The disease of alcoholism is a chronic and progressive illness that, if left untreated, could lead to both physical and mental health problems. Alcohol use disorders are among the most prevalent disorders seen in both inpatient and outpatient treatment centers. Alcohol abuse is a primary cause of preventable illness, disability and mortality in America.2 The disease may also worsen or complicate co-occurring conditions. Improving screening for people at risk for developing alcohol use disorders is one of the initiatives of the national enhanced services. 3 This practice should be followed in all healthcare settings because early identification and treatment leads to better outcomes. Nurses work closely with patients and play a critical role in the identification and treatment of alcohol use disorders. Therefore, providing education and training about AA and how the program is used to help alcoholics maintain sobriety is vital for nurses working in all healthcare settings.
Purpose of AA
Studies have found that Alcoholics Anonymous is an effective tool in facilitating recovery and yet it appears to be underutilized, or not understood, by nurses who work directly with people suffering from alcohol use disorders. Lopez-Bushnell and Fashler found that most healthcare providers receive little education for treatment of alcoholism and only two thirds of physicians and nurses felt prepared to deal with problems faced by this population.2 According to McGee, nursing theory and practice can benefit from Alcoholics Anonymous’ concept of holism, empowerment and increase in spiritual knowledge. 4
So, what should nurses know about AA? The goal of AA is simple: to help fellow alcoholics achieve sobriety. “Alcoholics Anonymous is a fellowship of alcoholic men and women. The only requirement for membership is the desire to stop drinking.” (Alcoholics Anonymous, 2001, p. xn). 5 Alcoholics Anonymous was founded in 1935 by Bill W. and Dr. Bob S. It is a twelve step recovery program that assists the alcoholic to rid the obsession to drink alcohol and maintain sobriety. Although attendance and participation in meetings is the core of the recovery program, participation in AA consists of more than just attending meetings. The impaired alcoholic works through the twelve steps with a sponsor. The desired outcome is not just abstinence from alcohol. The program focuses on complete transformation of the alcoholic self.4
Basic Understanding of the Program
Having a basic understanding of the twelve steps is important. The twelve steps are listed in Appendix A. The most important step is the first one; acknowledging powerlessness over the use of alcohol. Unless the alcoholic admits that he/she has a problem then they will not progress in their recovery. Nurses need to understand that not every alcoholic has realized that they have a problem with alcohol, to avoid feeling frustrated if their efforts to help them are not producing results. The alcoholic has to be willing and ready to get better.
AA has a focus on spirituality, however it is not a religious program. Discussion of a higher power in the twelve steps leads to misconceptions about AA. A person’s higher power can be whatever they want it to be and does not have to be related to religion. This is important for the nurse to understand and convey to the person needing help. The fear of religious affiliation may keep a person from becoming involved if they don’t have an adequate understanding about the differences between spirituality and religion.
Next, the nurse should be knowledgeable of community resources available for the patient to reach out to if he/she decides to get help. The desire to stop drinking hascome from the alcoholic for help so the nurse can be supportive and facilitate the first steps. AA has 24/7 telephone support services that can be called anonymously. The AA support staff can assist a person to find a meetings close to them and/or offer support when they are struggling to stay sober. AA also has directories by state that list the time, location, day of the week and type of meeting being held. The meetings are offered at different times throughout the day, morning and evening. The most important point that nurses can rely to patients considering joining AA is that there is always someone out there, within reach that wants to help a fellow alcoholic in need.
Sharing a Common Goal
The aa.org website has information specifically for healthcare providers. Alcoholics Anonymous and healthcare providers share the same goal of helping alcoholics stay sober and lead healthy and productive lifestyles. The AA fellowship seeks to work collaboratively with healthcare workers but will not offer suggestions for medical treatment. AA is “not allied with any sect, denomination, politics, organizations or institutions.”6 The primary purpose of Alcoholics Anonymous, as stated in the preamble is “to say sober and help other alcoholics achieve sobriety.” 7
In conclusion, alcoholism affects many people in the United States and poses many risks to health. Nurses work with alcoholic patients in a variety of settings and they lack understanding and knowledge about Alcoholics Anonymous. Membership in AA is a predictor of positive outcomes and sustained recovery from alcoholism.8 Nurses should be educated about AA and employers should offer education and resources about Alcoholics Anonymous to their employees. Alcoholics Anonymous has literature and resources for alcoholics and for health care providers to promote understanding. Increasing nurses’ knowledge and awareness may lead earlier intervention for the treatment of alcohol use disorders, better outcomes and fewer health disparities.
The Twelve Steps of Alcoholics Anonymous 9
- “We admitted that we were powerless and that our lives had become unmanageable.”
- “Came to believe that a Power greater than ourselves could restore us to sanity.”
- “Made a decision to turn our will and our lives over to the care of God as we understand Him.”
- “Made a searching and fearless moral inventory of ourselves.”
- “Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.”
- “Were entirely ready to have God remove all these defects of character.”
- “Humbly asked Him to remove our shortcomings.”
- “Made a list of all persons we had harmed, and became willing to make amends to them all.”
- “Made direct amends to such people wherever possible, except when to do so would injure them or others.”
- “Continued to take personal inventory and when we were wrong promptly admitted it.”
- “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.”
- “Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”
1.Hansen, M., Ganley, B. & Carlucci, C. (2008). Journeys from addiction to recovery. Research and Theory for Nursing Practice: An International Journal. 22 (4), 256-272.
2. Lopez-Bushnell, K. & Fassler, C. (2004). Nursing care of hospitalized medical patients with addictions. Journal of Addictions Nursing, 15, 177-182.
3. Hamilton, I., & Baker, S. (2013). Nurses’ role in tackling problematic alcohol use. Practice Nursing. 24 (7), 351-355.
4. McGee, E. M. (2000). Alcoholics anonymous and nursing: Lessons in holism and spiritual care. Journal of Holistic Nursing. 18 (1), 11-26.
5. Alcoholics Anonymous. (Ed. 4). (2001). Alcoholics anonymous: The story of how many thousands of men and women have recovered from alcoholism. New York City: Alcoholics Anonymous World Services, Inc.
6. Alcoholics Anonymous. (1986). If you are a professional [pamphlet]. New York, NY: Alcoholics Anonymous World Service, Inc.
7. AA Grapevine. (n.d.). Regarding the preamble. Retrieved 3/30/2015 from http://www.aagrapevine.org/feature/2976
8. Krentzman, A.R., Robinson, E.A.R., Perron, B.E., & Cranford, J.A. (2011). Predictors of membership in alcoholics anonymous in a sample of successfully remitted alcoholics. Journal of Psychoactive Drugs, 43(1), 20-26.
9. Alcoholics Anonymous. (2011). Twelve steps and twelve traditions. New York City: Alcoholics Anonymous World Services, Inc.
Daisy Brown is a psychiatric nurse case manager, New England Home Care, Windsor, Conn. and an LPN Instructor at Lincoln Technical Institute, New Britain, Conn.