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This is to certify that the

dissertation entitled

A STUDY OF THE PERCEIVED ATTRIBUTES
OF ALCOHOLICS IN SELF-HELP GROUPS REGARDING
THEIR CURRENT STATES OF SOBRIETY

presented by

Lisa Beth Parsons

has been accepted towards fulfillment
of the requirements for

MS degree in Parké Recreation
and Tourism Resources

  
   

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Major professor

Date 111%—

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Unlverslty

 

 

 

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TO AVOID FINES mum on or More data duo.

DATE DUE DATE DUE DATE DUE

       

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSU I: An Affirmative Action/Equal Opportunity lm
WM1

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A STUDY OF THE PERCEIVED ATTRIBUTES OF ALCOHOLICS
IN SELF-HELP GROUPS REGARDING THEIR
CURRENT STATES OF SOBRIETY
By

Lisa Beth Parsons

A THESIS

Submitted to
Michigan State University
in partial fiilfillment of the requirements
for the degree of

MASTER OF SCIENCE

Department of Park and Recreation Resources

1 994

ABSTRACT

A STUDY OF THE PERCEIVED ATTRIBUTES OF ALCOHOLICS
IN SELF-HELP GROUPS REGARDING THEIR
CURRENT STATES OF SOBRIETY

By

Lisa Beth Parsons

This was an exploratory study in which the perceptions of alcoholics at a local
Alcoholics Anonymous club were surveyed regarding topics such as the Alcoholics
Anonymous program, treatment backgrounds, recreation practices and demographic
information. This study introduced a methodology which would gain access to
anonymous organizations without violating confidentiality of subjects. The method used
indicated that study of alcoholics in the recovering coMunity is possible. The role of
recreation was identified as important to recovering alcoholics in a successful recovery
program and ofi‘er insight to future research exploring any cause-efi‘ect relationship. This
study also identified confounding variables which needed to be controlled by the

researcher.

This paper is dedicated to all those brothers and sisters still living in the madness. May
work such as this help you find the circle of recovery and the peace of serenity in the
battle against addiction.

ACKNOWLEDGMENTS

At this time I would like to recognize the efforts of those individuals who helped
me find my path in the academic realm and assisted in my growth and understanding of
people, recreation, alcoholism, research and faith in myself. I thank Rick Paulsen, Dan
Ferguson and Terry Hagan for their time and efl‘ort involved as members to my
committee; Dan Stynes who took the time to help me fine tune my instrument and my
writing of the methods; Gail Vander Stoep who helped me design the questionnaire
booklet into a professional research tool and introduced me to the world of Microsoft
Word; and finally James Bristor, Chuck Nelson, Gaylan Rasmussen, and Betty van der
Smissen who provided support, encouragement and education to me along the way. I
would also like to recognize and give thanks to those people in my personal life who have
helped make me what I am today: Mom, Dad, Leslie, Dan, my former clients, associates,
fiiends and thanks to the experiences I have lived through.

iv

TABLE OF CONTENTS

Page
CHAPTER I: INTRODUCTION AND PROBLEM STATEMENT
Introduction .......................................... 1
Need for this Study .................................... 2
Research Problem ..................................... 4
CHAPTER II: LITERATURE REVIEW
Characteristics of Alcoholism ............................. 6
Alcohol and Recreation ................................. 8
Theories of Alcoholism ................................. 8
Theories of Recovery .................................. 9
Early Theories of Recovery and Natural Recovery ....... 10
Alcoholics Anonymous ............................ 11
Recovery and Recreation .......................... 12
Theories of Relapse ................................... 14
Learning Theories and Relapse ...................... 14
Stress, Social Support and Relapse ................... l6
Relapse and Relapse Prevention ........................... l7
Techniques in Treatment ................................ 18
CHAPTER III: METHODOLOGY
Subjects ............................................. 20
Design and Procedures ................................. 20
Instrument Development .......................... 21
Sampling Procedures ............................. 27
Data Analysis ........................................ 3O

CHAPTER IV: RESULTS AND CONCLUSIONS

Results and Discussion ................................. 32
Subjects ...................................... 32
Research Questions ............................. 34
Discussion .................................... 37
Conclusions and Recommendations ........................ 39
Appendices
Appendix A: The Twelve Steps of Alcoholics Anonymous ...... 42
Appendix B: The Twelve Traditions of Alcoholics Anonymous . . . 43
Appendix C: Meeting Times at Alano Club East .............. 44
Appendix D: Pilot Cover Letter ........................... 45
Appendix E: Initial Instrument ............................ 46
Appendix F: Study Cover Letter .......................... 55
Appendix G: Study Questionnaire ......................... 56
Appendix H: Positive Attribute Rankings of 30% Positive
Endorsement or Higher ........................... 65
Appendix 1: Negative Attribute Rankings of 20% Negative
Endorsement or Higher ............................ 66
Bibliography ............................................... 67

LIST OF TABLES

Title Page
Table 1: Surveyed AA Meeting Times ........................... 29
Table 2: Demographic Composition of Sample .................... 33
Table 3: Statements About Recreation and Recovery ............... 3 5

Table 4: Positive Attributes where Recreation or AA were Identified. . . 36

Table 5: Negative Attributes where Recreation was Identified ........ 37

vii

CHAPTER I

INTRODUCTION AND PROBLEM STATEMENT
Introduction

It is estimated that nearly 10.5 million individuals in the United States exhibit some
symptom of alcoholism and that an additional 7.2 million abuse alcohol, but do not yet
Show symptoms of chemical dependence (NIAAA, 1990). It is also estimated that an
alcohol-related family problem strikes one out of every four American families (N CADD,
1990). Nearly two-thirds of the United States adult population drink, but 10% of all
drinkers (those who drink most heavily) drink half of all the alcohol consumed each year
(NCADD, 1990).

Approximately 1.2 million of the estimated 17.7 million Americans with alcohol
problems have entered alcohol treatment programs (NCADD, 1990). In the treatment of
alcoholism, the most common outcome is relapse, a general term used to describe the
return to drinking (Stainback & Walker, 1990). High relapse rates are common, especially
during the first three months after treatment (Stainback & Walker, 1990; Vaillant, 1983).
Marlatt (1985) estimated over 90% of alcoholics relapse within two years following
treatment.

Research, based primarily on relapse rates, indicates that treatment programs and
support groups are ineffective in helping the majority of alcoholics maintain long periods
of abstinence (Epstein, 1990; Marlatt, 1985; Rancourt, 1991; Stainback & Walker, 1990).
According to Stainback and Walker (1990), treatment outcomes based on the time of
abstinence are affected by differences in treatment techniques as well as the individual

characteristics of both patients and staff (Montgomery et al., 1993). Researchers and

2
practitioners need to be able to identify and understand what factors are significant
indicators of successful recovery for their patients in order to provide more effective
treatment methods and increase recovery rates (Rancourt, 1991; Kufner & F euerlein,
1989). Recovery is viewed as a dynamic, lifelong process and can be defined in terms of
the extinction of conditioned responses connected to the use of alcohol that take place
over time usually with some form of intervention through treatment, aftercare or after
treatment program (Babor et al., 1986; Stainback & Walker, 1990). Intervention afi‘ects
recovery in that close family members, co-workers, and or clinicians take the first step in
addressing concerns of an addiction to the alcoholic and recommend treatment or self-help
groups. Treatment affects recovery by educating clients to the deadliness and
pervasiveness of the disease called alcoholism. Along with educating alcoholics about the
nature of the disease, treatment also identifies the tools used by recovering alcoholics to
maintain long periods of abstinence and identifies this entire process as recovery. Afier
care or after treatment programs relate to recovery in that they are designed to provide a

continuation of the recovery process begun in treatment or from an intervention.

Need for this Study
Current information related to the recovery process focuses upon the views of
practitioners (Edwards et al., 1987; Stainback & Walker, 1990) The relative ease of
gaining access to the views of practitioners about alcoholism and recovery has prompted
much of the research to focus on this information source. In comparison, reaching out to
the recovering community is considerably more difficult. There are many factors which
impact on the accessibility to the recovering community. Patient rights that insure the

confidentiality of patients in mental health clinics keep data from public access. In

3
addition, self-help groups such as Alcoholics Anonymous, hold traditions which insure the
anonymity of members and promise not to use the members as a research pool. See
Appendix B.

Due to the limited access of information from the recovering community, an
exploratory study was constructed to identify a method which could be utilized and
standardized in this field of research. An exploratory study is designed to discover if a
connection exists between factors often reported connected to a particular subject, to
describe a methodology not used with this particular population and to generally describe
the sample population.

In the relapse prevention model developed by Marlatt and his colleagues, relapse
prevention techniques are utilized as guidelines to identify potential relapse precipitants
and to construct alternative coping behaviors for the alcoholic (Marlatt & Gordon, 1980;
1985; Stainback & Walker, 1990). These techniques are based on research findings
involving demographics of alcoholics in treatment settings and identifying what
practitioners believe to be necessary for lengthy periods of abstinence (Gibbs & Flanagan,
1977; Marlatt & Gordon, 1980; 1985; Rancourt, 1991; Vaillant, 1983). Overlooked in the
literature is the value of an alcoholic's perceptions. The Twelve Step Program is the
account of two recovering alcoholics who were able to remain abstinent; their story and
perceptions are the foundation of self-help recovery programs. The recovering community
is a resource of treatment, learning and interventions that worked as well as what did not
work for the alcoholic.

Data, which support the notion that every individual's recovery process difi‘ers
(Stainback & Walker, 1990), also acknowledge that there may be similarities in the
recovery process within the alcoholic population. It is questionable whether previous
studies explored all potential variables that could influence the successfirl recovery of

alcoholics, or whether there are additional aspects. The alcoholic's perception of recovery

4
needs to be considered because treatment plans and aftercare plans are ofien developed
without taking pertinent factors regarding the alcoholic into account (Lerner & Barr,
1990). Of those pertinent lifestyle factors commonly discussed by medical professionals,
research into the role recreation plays in the recovery process has not been initiated
(Rancourt, 1991).

Within the diagnostic criteria of chemical dependency, recreation participation is
identified as one potential indicator for the disease. The reduction of participation in
recreation activities is considered a diagnostic component when, "Important social,
occupational or recreational activities are given up or reduced because of substance use.
The person may withdraw from family activities and hobbies to spend more time with
substance-using friends, or to use the substance in private " (DSMIII-R, 1991, p. 167).
According to this diagnostic tool, recreation participation is often decreased to allow more

time for the consumption of the chemical substance.

Research Problem

The research problem for this exploratory study was to determine the perception
of the alcoholic in recovery regarding the role recreation plays in his/her recovery process.
In addition, access or a method allowing access to the recovering community was
discussed as part of the research problem due to limitations encountered when working
with this population. The study discussed what role recreation activities played in the
recovery process and what factors the alcoholic attributed to his/her current state of
sobriety. Significant research questions considered to provide insights into this problem
were: Was recreation considered by the alcoholic as an important factor in the recovery?
How does the recovering alcoholic rank the relative importance of recreation against
variables found correlated with a successful recovery such as family support, marital

status, employment status, continuance of self-support programs? (Gibbs & Flanagan,

5
1977; Rancourt, 1991; Vaillant, 1983). What benefits do recovering alcoholics perceive
from recreation? Also explored was the amount of involvement in recreation and if that

involvement had an effect upon the length of sobriety.

CHAPTER II

LITERATURE REVIEW

Characteristics of Alcoholisin

According to the Diagnostic a_n_d Statistical Manual (American Psychological

 

Association, 1991), features of alcoholism are ”a cluster of cognitive, behavioral and
physiological symptoms that indicate the person has impaired control of psychoactive
substance use and continues use of the substance despite adverse consequences" (p. 166).
The National Council on Alcohol and Drug Dependence (NCADD) defines alcoholism as
"a chronic, progressive and potentially fatal disease marked by characteristics of tolerance
and psychological and/or physical dependency" (NCADD, 1990, p. l). The dependence is
such that the alcoholic exhibits a compulsion to continue to use the substance and is
unable to stop.

There are two types of dependency identified in the features of the addiction;
physical and psychological dependency (DSMIII-R, 1991). Physical dependency occurs
when an individual experiences altered physiological states due to regular, compulsive and
continuous use of a chemical substance. Psychological dependence is a condition which
drives the addiction and is considered a reinforcing effect (Rech, 1993). The
psychological dependency can continue long after the last drop of the alcohol has been
consumed (Maddux & Desmond, 1986).

Tolerance, another term often used when discussing characteristics of alcoholism,
is "a markedly diminished effect with continued use of the same amount of substance over

time" (DSMIII-R, 1991, p. 167). In many instances, the presence of tolerance requires the

7

increased consumption of the chemical to achieve the desired effect. Withdrawal
symptoms result from the cessation of alcohol. Withdrawal symptoms include, but are not
limited to, shakes, nausea and vomiting and can be alleviated when the alcoholic once
again begins using the substance, thereby reinforcing the behavior to drink (DSMIII-R,
1991)

In an attempt to determine prognostic statements about alcoholics, a study
conducted by Gibbs and Flanagan (1977) used lifestyle characteristics of alcoholic patients

and found ten positive predictors of treatment outcomes:

1. Patient married or living with a partner

2. Stable marriage or relationship

3. Employed at time of admission

4. High-Status job

5. Stable employment history at time of admission

6. High social class background

7. Psychoneurosis

8. Few arrests due to alcohol

9. Contact with Alcoholics Anonymous at time of admission
10. High score on Weschler's arithmetic subtest 10

Pre-treatment factors considered possible to predict recovery have also been examined.
For alcoholics, Vaillant (1983) found that social stability of familial and employment
issues, absence of arrests and late onset of alcoholism were identified as a positive
indicator for recovery. In another study by Vaillant (1983), factors linked specifically to

the issue of relapse included:

1. A genetic predisposition

2. A psychological predisposition

3. Physical dependence which may persist for months after use ceases
4. Operant and Pavlovian conditioning

5. Absence of protective conditions, such as stable social network

8

Alcohol and Recreaflon

In the United States, consumers spent nearly $88 billion on alcoholic beverages in
1988 (NCADD, 1990). Socially, the consumption of alcohol often occurs on weekends,
during parties, after payday, during Sporting events, on dates and dinners, as well as a
variety of other non-work times. These activities are often clustered into the general
category of "fi'ee time" activities. Free time, in the general population, has been found to
involve the use of alcohol (Simpura, 1985; Young & Kronus, 1977). Involvement in
recreation or leisure is somewhat lower for alcoholics than that of the general population
(Sessoms & Oakley, 1969; Tuchfield, 1981). If participation in recreation activities which
previously involved the use of drug and alcohol occurs, the alcoholic can experience some
difficulty and possibly experience a trigger to return to the use of alcohol or drugs
(McCormick & Dattilo, 1992). What the previous "use" time has been replaced with and
if in fact individuals who have applied activities to this time are better prepared for their
new role in recovery have yet to be discussed through research.

A common characteristic of alcoholism is that the alcoholic's time and many social
responses revolve around the preferred substance (DSMIII-R, 1991). Helping the
alcoholic find non-chemical alternatives to support the process of recovery has been cited
as an important variable (Epstien, 1990; Francis, 1991; Rancourt, 1991). One source of
non-chemical alternatives can be found in recreation activities. Not only must the physical
attachment or dependence to the chemical substance be broken, but the ability of the
alcoholic to restructure his/her lifestyle helps eliminate or reduce the opportunities for

relapse (Francis, 1991).

Theories of Alcoholism
There are many theories examining how an addiction such as alcoholism develops.

Alcoholism can be described using such theoretical beliefs which concern human nature

9
and development and come from theories like the medical model which considers an
addiction incurable to an approach that considers an addiction curable. Theories of
personality traits and self-esteem (Ausubel, 1980; Chein, 1980; Hendin, 1980; lessor &
lessor, 1980; Kaplan, 1980; Loney, 1980; Robins, 1980; Smith, 1980), genetic
predisposition (Bejerot, 1980; Goodwin, 1980; Hochhause, 1980; Schuckit, 1980), coping
mechanisms (Ausubel, 1980; Khantzian, 1980; Milkrnan & Frosch, 1980; Peele, 1980), I
and social and environmental influences (Becker, 1980; Chein, 1980; Coleman, 1980, E
Hendin, 1980; lessor & lessor, 1980; Loney, 1980; Schuckit, 1980; Smith, 1980) attempt i

 

to explain how alcoholism develops. Each theory can be used to offer insight into ways of i
treating or arresting the symptoms related to alcoholism and help place the disease in a

State of remission with abstinence and recovery. As pointed out by several researchers

who consider alcoholism curable, as long as the perceived positive effects of drug taking

out-weigh the perceived negative effects, people will continue to take dmgs irrespective of

the specific causes (Becker, 1980; Peele, 1980; Smith, 1980). Each of these causes and

individual characteristics creates sub-pOpulations within the disease. It seems logical to

assume that difficulty in treatment may directly correspond to the fact that the addiction is

a combination of many possible causes and thereby explains the relative ineffectiveness of

any one treatment approach (Lerner & Barr, 1990).

Theories of RecoveLv
Under the philosophy of Alcoholics Anonymous and various treatment centers,
alcoholism is an addictive disease that can only be treated and arrested, not cured
(Spickard, 1990; Appendix A). When an individual abstains fiom the use of any mood
altering substances, he/she is considered to be in the early stages of a lifelong process
known as recovery. Treatment of an addiction under the medical model does

acknowledge the need for the recovering individual to deal with the symptoms of the

10
disease. Once the use of the drug has stopped and the symptoms have been identified, the
recovery process can begin. The recovery process is designed to help identify how an
alcoholic can live a drug free life while understanding that the addiction, alcoholism, will
never disappear. This is a biopsychosocial process involving all aspects of an individual's
lifestyle and a process which needs work and dedication every day in order to live a happy,
healthy, and drug fi'ee life. Treatment centers often work from the approach that recovery
examines the past patterns of use, deals with the realities of relapse and how to avoid
returning to drug usage (Gorski & Miller, 1986). Theories about recovery often describe
a process of achieving and maintaining abstinence that is not directly related to any

particular type or philosophy of treatment (Wesson et al., 1986).

Early Theories of Recovery Wm

The concept of recovery fi'om addiction has been around for some time now. In
the early conceptual stages, alcoholism and addiction were considered developmental
phases that would eventually be outgrown alter considerable years of use and by age 35
(Wesson et al., 1986; Winick, 1962). This theory was known as the Maturation Theory
and adopted the practice of allowing the addiction to run its course. The original data
which supported this theory came for the statistical data of opiate users (Wesson et al.,
1986). The alcoholic could continue to drink, knowing one day his/her body would no
longer have a problem with the consumption of alcohol.

Individuals who no longer depend on chemical substances without the aid of
treatment or support groups are considered to have achieved a natural recovery of the
disease and are considered a phenomenon (Gorski & Miller, 1986). These individuals
generally use a variety of methods or tools to remain free of the chemicals and often find

new interests, new social relationships and new social identities (Wesson et al., 1986)

11
However, the majority of individuals waiting for the addiction phase to pass never
made it. As a direct result of the lack of success by this treatment approach to addictions,
a different approach regarding recovery emerged. This new theory was developed by the
efforts of two men who wrote down the steps they took to gain sobriety and is now the
basis of the Alcoholics Anonymous organization. The underlying assumption of this
theory is that an addiction is for life, therefore the process of battling the disease of

addiction needs to be a life long process.

Alcoholics Anonymous.

The Twelve Step recovery program as developed and practiced through Alcoholics
Anonymous, aids in the understanding of recovery, relapse and addiction. AS indicated by
the moral code in the program, ”Being in recovery implies that the person has accepted
that addiction is a lifelong, incurable disease; that the person is participating in 12-step
recovery groups; and that the person is leaming to live a comfortable and responsible life
without the use of psychoactive drugs." (Wesson et al., 1986 p. 15). Here to, the
concepts of recovery and relapse were viewed as processes. Within this group, new social
networks, new social identity and new interests are incorporated in the recovery steps.

The model Stresses the importance of remaining clear of any mood altering chemicals and
any use of drugs or alcohol is considered relapse. Vlfrthin this recovery tool, individuals
acknowledge that relapse does occur. Through the use of sponsorship and the helping
structure, the support group can cut the relapse time and the addict can re-work the steps
of recovery again. Alcoholics Anonymous identifies that the recovery process also
includes a relapse process. Relapse is not a single nor isolated event but rather the process
by which altered attitudes and thinking take hold often referred to as "stinking thinking"
(Gorski & Miller, 1986; Wesson et al., 1986). However, due to spirituality statements

often misconstrued as religious overtones within the conceptual framework, many

12
alcoholics are unable to utilize the ideas behind the theory (Wesson et al., 1986). Other
organizations, which parallel the self-help format of Alcoholics Anonymous, have
developed steps which deal with statements of personal choice, will power and

responsibility instead of misconstrued religious overtones (Gelman et al., 1991 ).

Recovena Ed Recreation

In the literature, recreation and community interests are highly stressed in the
recovery process (W anigaratne et al., 1990). It is common practice in many forms of
recovery groups to include activities as a way of working on coping skills and behavior
modification (Marlatt & Gordon, 1985; Wanigaratne et al., 1991). Prevention guide
books, which are used to aid the recovering alcoholic, include recreational activities and
leisure time assignments for the addict to work on during a session (Gorski & Miller,
1986)

In order to achieve long lasting sobriety, there needs to be something for the
alcoholic to look forward to during recovery (Francis, 1991; O'dea-Evans, 1990 ;
Rancourt, 1991). The application of recreation in the treatment program, along with
relapse prevention groups, can ofl‘er additional options in recovery and be beneficial to the
recovering community. The philosophy of utilizing recreation in recovery is aimed at
helping the alcoholic find alternative activities to replace their "use" time with more
positive and healthy drug free choices (Epstein, 1990; Francis, 1991; Rancourt, 1991).

Recreation participation can be a good medium for eliminating feelings of
loneliness and boredom commonly reported by recovering addicts, as well as provide an
alternative to the drinking (Chein, 1980; McAuliffe, 1980; Rancourt, 1991). In the clinical
or community setting, recreation can be incorporated into the biopsychosocial approach

towards treating the disease in a variety of ways. Rancourt (1991) listed some of the

13

treatment goals Therapeutic Recreation Specialists in the treatment setting which can

impact on a recovery program. The treatment goals identified include:

0...

A quality sobriety and improvement in overall life fimctioning.

Developing new non-chemical methods for obtaining needs.

Develop or improve problem solving and social interaction skills.

Help alcoholics manage/identify stressors without use of addictive behaviors.

Rancourt (1991) found that several researchers (Cohen, 1986; Kaplan, 1990; Kaufman

1990-91; Kunstler, 1992; Martin, 1990; O'Dea-Evans, 1990; Wallace et al., 1988; Wolber

et al., 1990) support the provision of recreation and leisure services in treatment. In many

instances the literature has suggested that recreation would be useful in treatment and it is

common to find practicing activity therapists or Certified Therapeutic Recreation

Specialists in treatment settings (Cohen, 1972; Glasser, 1976; Iso-Ahola, 1990; lulien,

1986; Kunstler, 1992). O'Dea-Evans (1990) listed a number of advantages of Therapeutic

Recreation (TR) in the treatment setting including but not limited to:

0

TR contributes to the overall recovery by assisting clients in learning leisure
alternatives and skills that will help them deal with new found leisure time.

TR enhances the ability to manage stress, teaches stress reduction skills and
provides escape of everyday tension.

TR reduces relapse, Studies Show a Significant increase in abstinence rates
when programs utilize TR services.

TR provides "leisure counseling" that can prevent "work addiction" and other
substitution addictions.

TR increases client self esteem, accomplishment and sense of self worth.

TR provides an appropriate outlet to process and practice feelings of
frustration anxiety, anger, depression, etc.

TR enhances opportunities for sober adventures, experiences and self creativity
while reducing boredom.

14
Recently, an exploratory study examining free time use and people with alcoholism
attending open Alcoholics Anonymous meetings in Urbana, Illinois, was published. It
offered insight into gaining access to this population group and identified the leisure
behaviors and attitudes (McCormick & Dattilo, 1992).

Theories of Relaasa

As stated earlier, there are a wide range of issues regarding recovery that need
further exploration. A number of factors which researchers and practitioners view to be of
importance to the alcoholic's recovery process have been identified, but clear relationships
are difficult to determine (Gibbs & Flanagan, 1977; Kufner & Feuerlein, 1989; Rancourt,
1991; Vaillant, 1983). Relapse is a component within the recovery process. Chances are
high that an alcoholic will experience at least one relapse during the struggle for long
lasting recovery (Marlatt, 1985; Martin; Stainback & Walker, 1990). From the
practitioner's stand point, the rate of relapse is determined not only by the definition used
to describe relapse, but also by the method used to determine whether a relapse has taken
place (Wesson et al., 1986). Relapse is most often considered the return to use of any
mood altering substance. Gorski (1986) and other relapse prevention experts consider
relapse not only the return to use of a chemical substance, but also the behaviors
developed within the addiction. Relapse is also a process, just like recovery. The relapse
process progresses towards the return to chemical use and can receive intervention before
the addict takes up use again or before the use is worse than before the period of sobriety
(Gorski & Miller, 1986).

garra'ng Thmries Ed Relapse

Learning theories can aid in the explanation of the alcoholic's recovery process.

Both social learning theory and conditioning techniques "explain initiation of drug use,

15
habituation, withdrawal and relapse" giving practitioners insight into treatment and
recovery for the alcoholic (Wesson et al., 1986 p. 8). Under the social learning theory, the
focus on the alcoholic and the potential for relapse come from a cognitive approach.
Models within this framework focus on the acquisition, maintenance and modification of
behavior by the alcoholic throughout treatment and recovery (Wesson et al., 1986). A
general model of relapse often used in social learning theories consists of the presence of a
high-risk situation confronting the alcoholic during a period of abstinence. Next,
determination of likely responses and expectations the alcoholic has regarding the
situation's resolve without the use of alcohol, and the resources and skills the alcoholic has
to deal with the high-risk situation are then explored and practiced (Wesson et al., 1986).
The model also supports the belief that relapse is a process by maintaining that situations
handled without use of alcohol increase expectations about self-control, mastery and
ability to remain abstinent. A return to the use of alcohol as a result of the high-risk
Situation can often lead to guilt and feelings of failure, which can precipitate further use
(Bandura, 1977; Wesson et al., 1986).

Social learning theory takes steps during the treatment and recovery process to
acknowledge patterns within the alcoholic's usage of any mood altering chemicals. It
focuses on the chain of behaviors and seeks to intervene at certain stages beginning with
what constitutes a "high-risk" for the individual all the way through a fill] fledged relapse
or return to alcohol or drug usage (Wesson et al., 1986). The development or
improvement of the alcoholic's coping skills is highly focused in this theory in an attempt
to equip the alcoholic with some defenses against the return to the use of alcohol or drugs
in high-risk situations. Wesson et al., (1986) further indicate that following a relapse,
"interventions include teaching clients how to limit or contain an episode of drug use
and... [teach] cognitive restructuring [which] involves conceptualizing the episode of use

as a limited slip rather than a major disaster; analyzing the high-risk situation; and learning

16
new coping skills" (p. 10). Social learning models address the reality of relapse within the
recovery process and utilize the experiences caused by the occurrence(s), instead of

blaming the alcoholic.

Stress, Social Support and Relapse
Stress and social support shed light onto the subject of relapse. It has been noted

that stress, operationalized as negative life events, is implicated in treatment failure and/or
as a cause of relapse (Wesson et al., 1986). However, the relationship between stress and
relapse is still unclear and may in fact be a secondary symptom of an impending relapse as
opposed to the cause of one (Wesson et al., 1986). Findings indicate that individuals
reporting large numbers of negative life events are often associated with individuals who
have already relapsed or with those persons considered to have poorer treatment
outcomes (Moos & Finney, 1983). In a study conducted by Cronkite and Moos (1980), it
was found that post-treatment stress affected alcoholic treatment outcomes, especially
level of depression. In addition, they found that stressors and coping responses were more
strongly related to outcome than family environment. As pointed out in a review by
Wesson et al. (1986), the results of the post-treatment study were unable to separate
stressors produced by the relapse fi'om stressors leading to a relapse. Stress or the coping
with stress has been indicated to be affected positively with participation in certain leisure
activities (Coleman, 1980). The use of leisure or recreation can in turn afi‘ect the levels of
stress in recovery.

Loosely connected to the theme of stress as a factor to relapse is that of social
supports. It is suggested that a good social support system can work as a buffer against
stressfiil events (Wesson et al., 1990). As has been noted, there seems to be evidence that

social support systems cannot only bufi‘er against stressfirl events but also produce a

17
general beneficial effect for the individual independent of stressful life experiences
(Wesson et al., 1990; Cohen & Wills, 1985).

It is noted within the theory of relapse prevention, that the particular social
structure the alcoholic returns to after treatment is important for a successful recovery.
Wesson et al. (1990), state that the support provided by the alcoholic's significant others
can have both positive and negative consequences. A healthy, balanced and open social
support or family system often increases chances for a good prognosis of recovery. With
a stable or strong support base, an alcoholic who is able to work on self-esteem and
restructuring his/her previous behaviors increase the chance of success. Studies indicate
that stable marital and familial structures correlate with outcomes of post treatment
alcohol consumption (Moos & Finney, 1983) as well as a significantly longer period of

abstinence before relapse for subjects with partners (Havassy et a1, 1986).

Relapse and Ralapse Prevention

Relapse prevention is a self control program that combines behavioral skills
training, cognitive interventions and lifestyle change procedures. It emphasizes self-
management and the techniques and strategies aimed at enhancing maintenance of habit
change (Wanigaratne et al, 1990).

According to one view of relapse prevention theory, a relapse is defined as the
process, occurring over a period of time, that returns the alcoholic to drug use of at least
the same intensity as in the past (Wesson et al., 1986). It does not have to be the previous
drug of choice, but of the same magnitude concerning use and pervasive behavior
problems. In addition, it is to be noted that an alcoholic may experience times commonly
referred to as a lapse, which is considered to be a one time or short term use of a
substance with a return to abstinence or treatment before the use turned into a pattern of

use (Stainback & Walker, 1990; Wesson et al., 1986).

18

Alcohol is often reported to be utilized as a coping mechanism for the alcoholic
(Huggins, 1990). When the stress is too high, life is too tough, and the personal problems
are mounting, consumption of alcohol is the easiest and often only way he or she knows to
numb the body and attempt to block out life‘s problems. It is suggested that the high rate
of relapse for alcoholics is due to the fact that they have not been able to adapt to new
coping skills and simply return to his/her older and more comfortable methods of drinking
(W anigaratne et al., 1990). Relapse prevention is designed to identify non-chemical ways
of dealing with high risk situations to decrease chances of relapse. Every recovering
alcoholic needs to learn how to deal with stress, anxiety, depression and anger without the

aid of mood altering chemicals (Gorski & Miller, 1986; Kunstler, 1992).

Techniques in Treatment

Treatment for alcoholism can be found in a variety of settings such as hospitals,
treatment centers, work, church or an Alcoholics Anonymous site. There is a common
assumption within these settings that for every person the recovery process is different and
that patients, matched appropriately to treatment, are expected to obtain superior
outcomes (Stainback & Walker, 1990). Treatment in most settings provides for alcohol
detoxification, a process of removing the physiological effects of the substance. In
addition to the physical needs, treatment also focuses on allowing the alcoholic to select
alternative methods in an attempt to deal with the long term effects of a psychological
dependence. According to Lerner and Barr (1990), it is important to provide alcoholics
with a strong support base to help them throughout the recovery process by assisting the
alcoholic in the selection of an on-going treatment and support program.

A multi-disciplinary treatment team is often employed in treatment facilities, giving
one overall program plan to all (Barr, 1990; Epstein, 1990; Lerner & Barr, 1990). The

patient experiences a wide range of therapies that can aid in his/her recovery process. The

19
exposure to varying therapeutic techniques is usefirl in developing the skills and behaviors
to deal with the lifelong process of recovery. However, personalizing various treatment
options to the patient based on initial assessment is still missing (Hester & Miller, 1989).
These therapeutic modalities often include such approaches as individual therapy, group
therapy, audio/visual educational presentations, written materials, lecture and adjunctive
activities (Epstein, 1990). Common approaches in treatment combine some or all the
following: individual evaluation, psychotherapy, marital and family therapy, insight
groups, problem-solving groups, family support groups, grief resolution groups, special
interest groups, relaxation training groups, assertion training groups, leisure counseling
groups, occupational therapy groups, relapse prevention groups, step groups adjunctive
therapy and audio-visual groups (Epstein, 1990).

In the identification of treatment goals for the recovering alcoholic, as noted by
Kunstler (1992) and Rancourt (1991), in many backgrounds both practitioners and
researcher stress issues of a quality sobriety and an improved overall life firnctioning in
which the goal is not only to remain abstinent, but to improve one's ability for effective
living. Rancourt's (1990) review of this topic indicates the importance of allowing the
alcoholic to explore non-chemical alternatives for meeting needs, desires and obtaining

personal goals (Kunstler, 1992).

20

CHAPTER III

METHODOLOGY
m
This was a study of the perceptions of recovering alcoholics in an Alcoholics
Anonymous support group regarding the role of recreation in recovery. Data were
collected during the period between August 16 and December 15, 1993. The study was
designed also to test the methodology used in gathering data from a group of individuals,
often considered inaccessible for research. Subjects in this study received full anonymity
and confidentiality in line with Human Subject standards and the Twelve Traditions of
Alcoholics Anonymous. See Appendix B. A recovering alcoholic was defined as an adult
who has identified that he/she cannot control the use of alcohol and was seeking help for

the disease through a Lansing area based Alano Club for Alcoholics Anonymous meetings.

Desigp and Procedures

The overall design of the Study was to gather information from a subject pool that
lived within the local community and has embedded the beliefs of the organization that
anonymity be guaranteed to each member. An instrument was developed and tested using
members of the Alcoholics Anonymous organization. Sampling and dispersement
procedures were established which insured the anonymity of each subject.

Throughout the literature there is limited research reported regarding recreation
and alcoholism. In a study examining free time and the alcoholic, observation techniques
were used in addition to participation in local Alcoholics Anonymous meetings

(McCormick & Dattilo, 1992). Due to the kind of information needed for this study and

21
in order to maintain anonymity, the methods used by McCormick and Dattilo (1992) were
not deemed appropriate. Methods which utilized the observation of Alcoholics
Anonymous open group meetings, those available to any individual, were not considered
appropriate to determine the attitude and beliefs of the target populationfor this study.
Even though Alcoholics Anonymous provides open and closed meetings, the Alano Club
East is always open to the public, not just individuals in recovery for alcohol. Therefore, a
selection method was developed to determine respondents who were in recovery and to
differentiate between family members of alcoholics and those individuals in recovery.
Since the researcher did not have any recovering alcoholic clientele, there was no clear
method that could be used as a model for obtaining a sample within the alcoholic

community.

Instrument Development

The following variables were included in this study and, thus, incorporated in the
instrument: whether recovering alcoholics considered recreation an important factor to
their recovery; how recovering alcoholics ranked recreation as an important factor in their
recovery as compared to Alcoholics Anonymous structures, family support, and work; and
amount of time recovering alcoholics spent in recreation activities. Each variable was
indicated to be of some importance in the literature (Gibbs & Flanagan, 1977; Rancourt,
1991; Vaillant, 1983). Questions were included to investigate the role of recreation in the
recovery process more in-depth than had been previously identified in the literature.

This instrument was a self-administered questionnaire booklet which requested a
variety of information on the recovery process, attributes of drinking, recreation activity,

and demographics. Information was also gathered on the individual's history of recovery

22
and his/her perceptions as an Alcoholic Anonymous (AA) member regarding recovery and
recreation.

There were seven categories included within the instrument: Participation in a
support group, Beliefs, Relapse factors, Treatment program information, Recreation,
Demographics, and Attributions inventory. The instrument was arranged in such a way as
to attempt to separate the different variables to be analyzed. See Appendix E.

Participation in a support group was designed with nominal and continuous
variables. The continuous variables included time spent at AA and longest period of
abstinence both of which would help gauge any differences in responses for the variable of
length of time associated with the AA organization. These questions helped provide a
range of AA member involvement.

An individual's belief in the Twelve Step Theory was addressed with two rank
order questions comparing the fundamental beliefs of the program (belief in a higher
power and belief and use of your support groups) with variables reported in the literature.
It was expected that many of the responses would be based on the teachings and beliefs of
the Twelve Step Program, since AA members were selected for the subject pool. See
Appendix A and Appendix B. Due to the AA structure those responses which are main
concepts of the Twelve Step Program were expected to be ranked as most important and
therefore to be confounding variables. As a result, those variables related to AA were
included to obtain an accurate measure of the role of recreation in recovery. The variables
were also thought to offer insight into differences in treatment and attributes regarding
recreation use and recovery based on gender, race, and education level (Lemer & Barr,
1990).

Following the beliefs category, relapse factors addressed in the literature were

placed on a Likert scale for analysis, then respondents were asked to rank the most

23
problematic factors to their recovery. Each factor reflected the works of O'Dea-Evans
(1990) and Rancourt (1991) as previously noted on page 12.

For those individuals who attended treatment programs, nominal scales were used
to examine length of stay and motivation for treatment. These were included to help
clarify and identify issues of potential confounding variables. Participation in treatment
and Alcoholics Anonymous versus participation in Alcoholics Anonymous only have an
undefined relationship throughout the literature. The question whether treatment was
potentially confounding in this study led to the inclusion of the variables of attendance in
treatment and participation in Alcoholics Anonymous in the instrument.

The amount of time spent in recreation activities by recovering alcoholics was
measured through responses in the section on recreation activities. Two different
measurement scales were used to quantify the time spent involved in recreation. The first
variable being a ratio scale measure of total hours per week spent in recreation activities
and the second method being an ordinal scale which measured the number of days a week
an individual reported involvement in recreation activities.

Demographics were obtained by nominal scales for the categories of age,
employment status, gender, race and education. The issue of demographic characteristics
influencing the chances of an individual becoming an alcoholic is discussed in the
literature, alcoholism being a heterogeneous disease which can affect anyone. However,
the relationship of successfirl recovery and particular demographic characteristics remains
undefined. The categories of age, gender, education, race and work also provided
crossbreaks about recreation participation.

The Attribution Inventory by Edwards et al. (1987) was the only section of the
instrument used from previous research. It should be noted that the Inventory was
modified with the addition of the following items: talking to an activity therapist,

increasing my fiee time, engaging in recreation activities, and being interested in physical

24
activities The item focusing on contact with an Activity Therapist used the same format
given to other types of counseling professionals listed in the Inventory. The title of
Activity Therapist was used instead of Recreation Therapist due to Lansing area hospital's
identification of Activity Therapy staff in their treatment centers. The item for increased
fi'ee time stemmed from access to assessment forms used by treatment centers in which the
researcher had work experience and the common reporting of clients who indicated that
free time was a problem for their recovery. The literature also indicated that fi'ee time
could pose a potential problem for alcoholics (Marlatt, 1990; Rancourt, 1991). Finally,
recreation activities and physical activities were included to determine any difference in the
participant's identification between social activities, recreation activities, free time
activities or physical activities.

This study sought to identify issues that the alcoholic felt important to his/her
success and continued sobriety. The survey items and response choices incorporated
recreation as a potential factor in recovery and presented the subjects with a variety of
other factors deemed significant to be tested (Gibbs & Flanagan, 1977; Kufner &
Feuerlein, 1989; Marlatt, 1990; Rancourt, 1991; Vaillant, 1983).

Pilot Study. The instrument developed was piloted to evaluate face validity because
there were items such as the leisure time involvement and Alcoholic Anonymous beliefs
that had not already been tested by other researchers in this particular format. The pilot
study also was conducted in order to insure clarity of instructions and to make sure that
the wording of Alcoholics Anonymous beliefs was accurate and that there were no missing
aspects to the Alcoholics Anonymous program.

The first step taken in this study was to contact the local Alano Club East and ask
about previous research that had been conducted with their organization. The club

manager informed the researcher that Alano clubs did not conduct nor support the use of

25
recovering alcoholics as part of research. He referenced the traditions of Alcoholics
Anonymous and suggested that the Central Alcoholics Anonymous office in Lansing be
contacted. The Central Alcoholics Anonymous office provided the name of a member
who was likely to have more information on accessing the recovering community.
Through a variety of phone calls with this AA member, a tentative method of accessing
the members at Alano Club East was outlined. The method needed to gain access to the
recovering community, to gather information about their beliefs regarding a successful
recovery program along with personal information about their own recovery progress.
The method included the use of the coffee shop located just outside the Alano Club East
meeting rooms. This area was considered open to all regardless of the type of meeting or
the topic of the meeting. This meant that although a meeting may be closed to any but
recovering addicts, non-recovering persons could still remain in the cofl‘ee shop without
disrupting the meetings or ofi‘ending the members. Gaining access to the meeting
members in accordance with AA traditions was considered a significant barrier to the
research. Much care and assurance needed to be given to those individuals participating,
yet gaining access also posed a challenge to the researcher for obtaining a pilot study
sample and subsequently gaining access to a significant number of Alcoholics Anonymous
members with the final instrument.

The organization of AA itself was not a participant in this study. Through contact
with members or on the questionnaire packets, no mention of the organization was
allowed. This was directly related to the promise the organization has for its members.
The organization states that it does not promote or support research studies on individuals
who are struggling to maintain their recovery. See Appendix A. Due to this restriction as
well as issues of anonymity connected not only through Alcoholics Anonymous, but with
Michigan State University's Human Subjects Review Board, direct contact was minimized

with subjects and all contacts were made without the use of any last names or methods of

26
connecting subjects to their survey responses. Face to face contact was made with the
participants by the researcher, only before and after AA meetings at the Alano Club East
in Lansing.

Through the various conversations in the conceptualizing stages of this study, the
contact member also agreed to assist the researcher in obtaining a sample of participants
from the various Alcoholics Anonymous meetings ofl‘ered for the pilot study. The initial
instrument was reviewed for the content and format not only with faculty experts in
questionnaire design and content at the University, but also with the contact member at
the central ofice. After review, twenty questionnaires were printed and given to the
contact member who then assembled fifteen individuals to complete the initial instrument
at the Central Alcoholics Anonymous oflice. Clarification on the directions to complete
the Attribute scale was needed from the researcher during the pilot test and was made
through a phone call from the contact member to the researcher's home. The remaining
five questionnaires were handed out to members not present at the oflice and they be
returned to the researcher by the contact member. Ten questionnaires were returned

within two weeks. Responses to the initial instrument were not used in the final analysis.

Final Instrument. On the basis of responses to the initial instrument in the pilot study,
instructions and content modifications and a layout design changes to the questionnaire
were made. Section five of the initial instrument was completely removed due to
confirsion and complaints regarding length of completion time. Information removed
included the subject's sponsorship in the program, current progress in the Twelve Step
Program, and the history for becoming involved in AA While these were interesting
questions, they were not germane to the initial research questions. Simplification of
relapse issues were needed to prevent confirsion by asking subjects if they have ever had a

relapse or a slip, yes or no. The final instrument was arranged and printed in booklet

27
form, placing the most time consuming section in the center of the booklet. Instructions
were added at each section heading, giving a brief description of the subject being
presented. Each question had words added to indicate the method of response ("circle
number", "circle only one answer", "rank...using the number one as most important" and
"circle any that apply"). Simple computer techniques of spacing, boxing and highlighting
sections of the instrument were employed to improve readability. Graphics were added
only on the cover and information from the cover letter was placed on the front page of
the questionnaire booklet to present a professional appearance. All questions and answers

were placed into the same design format giving an easy to follow layout. See Appendix

G.

Sampling Procedures

An initial review of the literature found a limited number of studies utilizing
subjects fi'om Alcoholics Anonymous organizations. Most of the literature focused on
practitioners who may or may not have been recovering addicts (Gorski & Miller, 1986;
Kufirer & Feuerlein, 1986). Other studies gathered subjects from the whole community by
sending mailings to the general public (Edwards et al., 1986). Another study, which
explored the recovering community, presented information on researcher observation
during open Alcoholics Anonymous meetings and conducted brief interviews with a
limited sample (McCormick & Datillo, 1990). Observations made during this study could
not guarantee that the subject observed was a recovering alcoholic since not all people at
open Alcoholics Anonymous meetings are recovering alcoholics. Previous studies that
focused on the recovering community utilized clients within a treatment setting and
utilized contact with clients after a follow-up period, which ranged fiom one month to five
years after discharge (Kufner & Feuerlein, 1989). The method of questionnaire

dispersement used in this study used a different approach than mentioned in previous

28
studies in order to address confidentiality concerns identified in the promises of Alcoholics
Anonymous. See Appendix B.

Packets for this study were handed out by the researcher at the coffee shop of the
Alano Club East. Each packet included: (a) a cover letter identifying the purpose of the
study, the confidentiality of information within the survey, the use of answers collected in
the study and that Michigan State University's Department of Park and Recreation
Resources was sponsoring the study and not the Alcoholics Anonymous organization; (b)
the questionnaire booklet; and (c) a stamped addressed return envelope.

Questionnaire packets were distributed by the researcher in face to face contact
with members at Lansing's Alano Club East in the building‘s coffee shop during a random
sample of all meeting times. See Appendix C. The Alano Club East holds 49 different
meetings throughout the week. Meetings begin as early as 11 am. and run until Midnight
Monday through Friday. Weekend meetings begin at 8 am. and finish at Midnight.
Originally, a systematic random sampling for meeting times for the dispersement of
questionnaire packets was attempted. By selecting every fourth meeting offered based on
the order identified in the meeting brochure a random selection would be made. However,
this method and the subsequent method of attempting to select every fifth or sixth meeting
excluded some days altogether and appeared to be repeating times and topics of meetings.
Since observations made by the researcher indicated that recovering alcoholics at the
Alano Club East have a tendency to go to meetings at the same time, a different selection
approach was necessary.

Presented in Table l are the meeting times where questionnaires were distributed.
Meetings were selected by the researcher choosing at least two meeting topics every day

of the week and trying not to duplicate topics or times.

29

 

 

Table I:
Surveyed AA Meeting Times.

DAYS TIMES TOPICS
Monday 11:30 am Beginner! Group

12 noon Nonsmokers Group
Tuesday 3:30 p.nr Big Book Group

6:30 pm 12 Step Group

8 pm. 12 Steps and Traditions
Wed 5:30 pm. Happy Hour East

8 pm. Celebration of Sobriety
Thursday 11:30am. 12 StepsGroup&NonSmokingGroup

6:30 pm. Women Only & Men Only Group
Friday 1 1:30 am. Discussion Group

12 noon Humble Best

3:30 p.nr Foundations Group

5:30 pm. New Hope Group
Saturday 8 am. Sunrise Group

9:15 am. Learning to Live

11:30 am. Promise Group
Sunday 6:30 pm Sunday Night Serenity

7 pm Each Day Group (Women)

8 pm. First 4 Steps

 

 

Each meeting was visited at least one time. All participants in this study were identified as
members of the alcoholic community through their own admission.

For this particular study, sixty questionnaire packets were distributed by the
researcher to available members at the Alano Club East coffee shop. No follow-up was
conducted. Non-response bias was considered a potential problem for this study

considering the high regard for anonymity of the membership.

Researcher's Impact. It is important to note the characteristics of the researcher. As with

other studies using interview format, the individual characteristics of the interviewer can

30
have an impact on the responses and return rate. The researcher was a 23 year old
Caucasian female, five feet three inches tall and weighed 107 pounds. In addition, the
researcher had been working with recovering addicts for over two years. The researcher
possessed an understanding of the disease of alcoholism and a great deal of empathy for
individuals struggling with their addiction and recovery. The researcher would Show up
an hour before the selected meeting and stay up to an hour after the meeting time to insure
time to speak with members. In addition, she often spoke with the coffee shop workers or
was seen talking with other members. From an outsider's perspective, the researcher
appeared to fit in with the other people coming to the club. When approaching potential
subjects, the researcher identified herself, her connection with the University and the intent

of her study which explored the recovering alcoholic's perceptions.

Data Analysis

Because of the nature of the data and the small sample size, analysis of the data
involved descriptive statistics. Percentages and means were used to describe the
demographic characteristics of subjects, the length of time involved in AA, and the length
of longest abstinence. Frequency counts and rank orderings were used to determine how
important subjects regarded recreation in their recovery process. Quality of the recreation
experience and benefits gained fiom recreation were the focus, rather than the average
time of participation. This was analyzed by reviewing the open ended responses. A
correlation was done on length of time involved in AA and longest period of abstinence to
examine the possibility of confounding variables.

Initial analysis of the data fi'om the Attribution Scale by Edwards et al. (1987),
involved the ranking of attributes which respondents felt were "helpful" or "harmfirl" to
their alcohol consumption. Attributes were ranked by percentage of responses in one of

two categories. In the first set, responses for items which were marked as " greatly helped

31
stop my drinking" and "somewhat helped stop my drinking" were grouped together as a
positive attribute. Each attribute percentage was calculated based on the individual item's
sample size. In the second set, responses marked as "made my drinking worse" and "made
my drinking very much worse" were grouped together to indicate attributes with a
negative impact. The responses which indicated "no bearing, never experienced" were
considered neither positive nor negative. The data analysis conducted by Edwards et al.
(1987), was not used for this study because items which were added to the inventory were

being examined to see how they related to the overall positive and negative attributions.

32

CHAPTER IV

RESULTS AND CONCLUSIONS

The purpose of this study was to address the question regarding the role of
recreation in the process of recovery for the alcoholic, as well as to assess a method for
gathering data from a population with strong concerns regarding the protection of their
anonymity. This Chapter is in two sections: (1) Results and Discussion, and (2)

Conclusions and Recommendations.

Results and Discussi_on_
west;
Response Rate. Sixty questionnaires were distributed; 31 questionnaires were returned
for a response rate of 51% and 28 members opted not to return the questionnaire. One
questionnaire was returned, but more than 95% of the survey was left blank, so it was not
usable. Only three potential subjects, when offered a questionnaire, chose not to
participate and refused to take the questionnaire. Follow-up procedures to increase the

response rates were not considered feasible due to the anonymity required.

Demoggphics. There were 31 subjects, all over the age of 18 years. There was an almost
even division of female subjects (45%) and male subjects (54%), which was considered
unusual. Due to stigma, women are considered under represented in both treatment

centers and recovery programs. The study was composed of 87 % Caucasian subjects.

33
There was only one respondent each for Afiican American, Asian and Hispanic races.
One subject did not indicate race on the questionnaire. The composition of the sample
was not the result of any distribution bias, but rather to the Alcoholics Anonymous club's
general membership composition. During the meeting times sampled, observation by the
researcher recorded only two Afiican Americans, one Asian, two Hispanics and one
Native American at the Alano Club. All subjects reported having at least a high school
diploma or General Education Diploma. See Table 2.

 

 

Table 2.
Demographic Composition of Sample
Dmosnphic Cmcsoo' Frequency Permit“
Age
18-24 1 2
25-34 9 29
35-44 13 40
45-54 2 6
55-64 2 6
65 up 4 12
Gender
female 14 45
male 17 54
Education
high school diploma or G.E.D 4 12
some college 1 l 35
college deg'ee 10 32
post gradufe study or degree 6 19
Race
Caucasian 27 87
African American 1 2
Himnic 1
Asian 1 2
aPercerrtageamaynottotal100 duetorounding, n = 31.

 

 

The mean time of abstinence reported by respondents was 67.4 months, whereas
the overall time spent attending AA was 76 months. There is a strong linear relationship

between these variables with a correlation of 0.95 1. This corresponds with the

34
expectation that relapse does occur within the recovering process. Age also was
associated to both time at Alcoholics Anonymous and time of abstinence.

The study was designed to identify characteristics or variables related to recreation
and recovery, and was not to determine cause-efi‘ect relationships. Each demographic
characteristic variable has certain implications to the questions posed. However,
generalizations and detailed statistical analyses were restricted due to the limited sample

size.

Research Questions

One question posed in this study was the alcoholic's view and use of recreation in
recovery. Of the 31 responses, 27 subjects currently recreated and only 4 subjects did not.
Of the 4 who did not currently participate in recreation, reasons for the lack of
involvement included health reasons, current in-house arrest program, lack of time, and
working too much. As far as participant involvement in activities, 6% of respondents
claimed that they did not recreate. Other than that, the, mean participation in recreation
activities was 3-4 days each week for about 5-8 hours each week.

Further analysis of the role recreation plays in recovery focused on how subject's
involvement with recreation compares "before treatment" and/or "before involvement in
Alcoholics Anonymous". F ifty-one percent of the subjects identified more involvement in
recreation at the time of the study than before entering treatment. Seventy-five percent
reported more involvement in recreation at the time of the study than before entering AA.
Only one subject stated less involvement in recreation at the time of the study than before
entering treatment or AA.

In the choice of statements regarding recreation's impact on recovery,
approximately 97% of the respondents felt that "recreation was important to or Should be

a larger part of their recovery". None of the respondents felt that recreation distracted

35

from the recovery process. Even for the one respondent who did not believe recreation

was a part of his/her recovery, recreation was not viewed as negative. See Table 3.

 

Table 3
Statements About Recreation and Recovery.

Frequency of Respome Statement
19 Felt Recreationwas importarrttotheirreeovery
0 Felt Recreation was a distraction to their recovery

1 FeltReereationwasnotapar-tofrheirreeovery
ll FeltRecreationshouldbealargerpartoftheirreeovery

 

 

 

In the open ended questions, respondents described a variety of feelings and
situations in which recreation benefits his/her recovery. Recreation was reported to help
with loneliness, curb depression, socialization, time management, inner balance, anger,
relaxation, stress, boredom, self-esteem, physical health, teach patience, learn to laugh
again and to learn about oneself. All impacts mentioned by participants support the

literature discussed in Recaeation and Recovery on page 13.

Positive Attributes. Items in the Attribution Scale that related to the beliefs and traditions
of Alcoholics Anonymous were rated extremely high by the sample population. Attributes
which can be influenced by recreation included "learning to relax" with a 94% positive
endorsement, "understanding myself better" 90%, "being involved in social activities 65%,
"being interested in physical activities" 48%, "engaging in recreation activities" 39% and

"increase in my fiee time" 35%. See Table 4 and Appendix H.

36

 

Table 4
Positive Attributes where Recreation or AA were Identified
POSITIVE
RANK ATTRIBUTE ENDORSEMENT
1 AA in general 100
" Hearing other people's stories at AA 100
3 Believing in a higher power 97
" Telling my own story to others 97
" Finding friends through AA 97
6 Reminding myself of the positive consequences to sobriety 94
" beaming to relax 94
9 Taking an interest in other people 93
12 Understanding myselfbetter 90
" Stopping feeling sorry for myself 90
17 Wanting my selfrespect 83
18 Keeping away from drinking parties 81
19 Feeling able to love 74
20 Dealing with my resentments 73
" Getting over depression 68
25 Being involved in social activities 65
26 Keeping out/away from bars 61
28 Being in a treatment center 58
" Engaging in Recreation activities 39
45 her-easing my the time 35
46 Always being on guard 32

 

 

 

Iiegative Attributes. Results for those attributes listed as "harmful " to the recovery
programs of respondents are indicated in Table 5. These attributes were ranked according
to the percentage of times respondents found these to have "made my drinking worse" and
"made my drinking very much worse". Several attributes appear in both tables 4 and 5:
"Increasing my free time" and "engaging in recreation activities", which received
endorsements of 35% and 39%, respectively, also appeared in the negative attributes of

recovery at 42% and 35%, respectively.

37

 

Table 5
Negative Attributes where Recreation was Identified .
NEGATIVE
RANK ATTRIBUTES ENDORSEMENT
1 Being or feeling lonely 90
4 Keeping away from thinking parties 81
6 Determination to drink like others 77
8 Using alcohol to be less shy 71
10 Always being on guard 52
1 1 Increasing my free time 42
12 Engaging in recreation activities 35
14 Getting over depression 29
16 Using tranquilizers 23

 

 

 

Discussion

Some significant aspects of methodology were identified for practical use with this
population. A number of issues presented themselves during and after the operation of
those methods identified earlier. The random selection of meeting times did present a
dilemma for the researcher when the same individuals were encountered at randomly
selected meetings. Since it was typical for members to attend more than one meeting a
day and often seven days a week, the researcher encountered meetings where all members
in the coffee shop had already been approached to complete a questionnaire for the study.

The initial response rate was high considering there was no follow-up method
employed. Complications arose when responses were slow to be returned. The majority
of questionnaires were handed out after Thanksgiving with a deadline of December 15,
1993, which may not have given some individuals enough time to return the survey.
Postings and flyers at the club were strictly reserved for Alcoholics Anonymous meeting
information and were not allowed to be used for follow up notices. Flyers left on the
tables to remind individuals who had not returned their surveys would be thrown away
after the meeting took place according to the policy of the Alano manager. In addition, no
record was kept to detemrine who received a questionnaire other than in the memory of

the researcher. This limitation is in direct response to the promise of anonymity for the

38
respondents. Each questionnaire excluded any space or line asking for name or personal
identification and envelopes issued for return mail purposes already had the department
address stamped to eliminate the need for a return address.

The face to face contact of the dispersement procedures did allow for assurance
that each participant was a recovering alcoholic. One potential subject who refused a
questionnaire was actually at the Alano Club to support a recovering spouse. The subject
identified herselfas having a relationship with the Al-Anon program for family of
recovering alcoholics and not AA This subject therefore was not able to accept a survey.
Her husband was offered a survey but opted not to complete one.

The acceptance and subsequent return rates may have been affected by the
characteristics of the sample. Although the sample consisted of members from a Lansing
area meeting club, the demographic composition of the sample more closely resembled
East Lansing's population than that of Lansing's. This may be due to the close proximity
of East Lansing and Michigan State University to the East Club. In particular, the large
percentage of subjects with at least some college experience may have resulted in subjects
who appreciated the value of research, thereby affecting the return rate. It may also be
true that the researchers demographic characteristics closely resembled those of the AA
members and accounted for the return rate. In any case, the characteristics of this sample
are not representative and restrict generalization to the population of recovering alcoholics
as a whole.

An additional dimension of community interests and opportunity to recreate by the
respondents may have a bearing on responses collected and the response rate. Availability
of community recreation resources may play a role in the large percentage of subjects
reporting involvement in recreation. “frth the resources of Lansing, East Lansing, and

Michigan State University at the disposal of the subjects, it is possible that the opportunity

39

for recreation plays a factor on the use of recreation in recovery just as the lack of
resources in a community might correspond to a low report of recreation involvement.

Age and time involved with AA were both strongly correlated to each other in
addition to being strongly correlated to the variable of the longest length of time in
abstinence. These relationships are confounding and need to be controlled in order to
statistically determine the affect of recreation in successful recovery and not the affect of
age or time involved with AA. Age and longest length of time in abstinence were highly
correlated, which is logical since long term sobriety can happen only when the recovering
alcoholic has lived for a number of years. It was not anticipated that people just over the
age of 18 would have longer lengths of sobriety than respondents whose ages were in the
50's or 60's. The subject's response indicating that recreation did not present a distraction
from their recovery, yet recreation related items scored as likely to make one's drinking
worse on the Attribution Inventory, identified an interesting contradiction in responses.
Recreation may have been viewed, overall, not to distract from recovery or it may be that
the subject responded to the attributions at a time before recovery began and alcohol use
took place during recreation activities. These are some interpretations which cannot be

clearly answered by the data gathered in this study.

WW
Through this study, a method of gaining access to a specific population group
considered unreachable was developed. Even though there were many issues which
needed adjustment or modifications, the overall dispersement method employed provided
a high initial return rate and the possibility of adding follow-up procedures. Although the
sampling method in this Study was a process determined by constraints associated with the

population limitations, another study conducted by Montgomery et al. (1993) published

40
after this study was begun verified data collection methods in that they used similar
sampling procedures and dispersement methods to gather information from the recovering
community. Time, openness and direct participant-researcher contact are necessary to
insure a high initial response rate, as well as, approaching the recovering community for
their help and input. Future research with this group needs to plan for a long dispersement
period in order to receive a statistically significant sample size to breakdown the responses
to specific attribute items and analyze them using other variables such as time spent in
recreation, time Spent in AA and participation in a treatment program.

The instrument used in this study would benefit fiom additional modifications.
Other questions under treatment could be minimized to allow the subject more time to
respond to items in the recreation and attribution sections. Further examination into
attributes which scored as "no bearing" can be examined closer to determine whether there
is a need for changes in programming in the recovery process to address particular
attributes. The booklet format was very professional in appearance, but envelopes which
fit the booklet without any folding would be encouraged for firture studies.

The study identified that recreation is important to recovering alcoholics. It also
identified the dilemma that some individuals experience recreation as a positive factor on
sobriety and others find it a negative factor. Further investigation as to why this
perception exists needs to be undertaken to clarify the potential benefit in recovery and to
help individualize recovery programs. The answer to this question may also provide
insight into the reasons for relapse in recovery. If recreation poses a threat to recovery,
c0ping strategies need to be developed on in treatment and/or community AA meetings to
help the alcoholic work through difficulties as they develop. If recreation represents
Stability or improved chances at success in recovery, recreation skill development can be

incorporated into the treatment setting as well as in community programs such as AA.

41

Through results found in the attribution scale, one can argue that recreation and
leisure time presents both potential benefits and negative consequences to the recovering
alcoholic. Based on these results, it would seem that time spent in treatment and recovery
should focus on the patient's leisure time to provide the recovering alcoholic an
understanding that during activities, his/her guard may drop and a return to the use of
alcohol can occur. On the positive note, patients need to have hope for the future. The
recovering alcoholic needs to have something "firn" and "enjoyable" in his/her lifestyle
change. He/she needs to find non-chemical ways of dealing with emotions and situations,
ways which can commonly be found in the realm of leisure or recreation activities.

In treatment centers throughout the country, the benefits of recreation for clients
has been recognized through the incorporation of leisure education and activities into
treatment programs. However, recreation and leisure counseling remain a low priority in
the treatment of recovering alcoholics. Information pertaining to the benefits and potential
pitfalls of recreation needs to be examined to determine what it takes to remain drug fi'ee
and how to prevent a relapse. It is the hope of the researcher that firture study can
provide a clearer understanding of the impact recreation has on individuals struggling for
recovery. This understanding can be used to improve success rates and help maintain
longer periods of abstinence in the ongoing battle against alcoholism. The process of
recovery is a life-long struggle in which new information will always be usefirl in
understanding the disease of alcoholism. It appears that recreation may be a helpfirl tool
in the process of successfirl recovery. This topic deserves serious investigation to discover

its firll potential.

APPENDIX A

42

Appendix A

The Twelve Steps of Alcpholics Anoaymons

1.

10.

ll.

12.

We admitted we were powerless over alcohol - 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

Ederstpm 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
g 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 the result of these steps, we tried to carry this
message to alcoholics, and to practice these principles in all our afl‘airs.

APPENDIX B

43

Appendix B

The Twelve Tram'tions of Alcoholics Anonymous

1.

10.

ll.

12.

Our common welfare should come first; personal recovery depends upon
Alcoholics Anonymous unity.

For our group purpose there is but one ultimate authority - a loving God as He
may express Himself in our group conscience. Our leaders are but trusted
servants; they do not govern.

The only requirement for Alcoholics Anonymous membership is a desire to stop
drinking.

Each group should be autonomous except in matters affecting other groups or
Alcoholics Anonymous as a whole.

Each group has but one primary purpose - to carry its message to the alcoholic
who still suffers.

An Alcoholics Anonymous group ought never endorse, finance, or lend the
Alcoholics Anonymous name to any related facility or outside enterprise, lest
problems of money, property, and prestige divert us from our primary purpose.

Every Alcoholics Anonymous group ought to be firlly self-supporting declining
outside contributions.

Alcoholics Anonymous should remain forever non-professional, but our service
may employ special workers.

Alcoholics Anonymous, as such, ought never be organized; but we may create
boards or committees directly responsible to those they serve.

Alcoholics Anonymous has no opinion on outside issues; hence, the AA name
ought never be drawn into public controversy.

Our public relations policy is based on attraction rather than promotion; we need
always maintain personal anonymity at the level of press, radio and films.

Anonymity is the spiritual foundation of all our traditions, ever reminding us to
place principles before personalities.

APPENDIX C

Appendix C

Magting Times at Alano Club East

Monday 11:30 am. Saturday 08:00 am.
12:00 noon 09:15 am.
03:30 pm. 09:15 am.
06:30 pm. 11:30 am.
08:00 pm. 11:30 am.
08:00 pm. 02:00 pm.
06:30 pm.
Tuesday 11:00 am. 08:00 pm.
11:00 am. 08:00 pm.
01:30 pm. 11:00 pm.
03:30 pm.
06:30 pm. Sunday 09:00 am.
06:30 pm. 09:00 am.
08:00 pm. 01:00 pm.
03:00 pm.
Wednesday 11:30 am. 06:30 pm.
03:30 pm. 07:00 pm.
05:30 pm. 08:00 pm.
08:00 pm.
10:00 pm.
Thursday 11:30 am.
11:30 am.
03:30 pm.
05:30 pm.
06:30 pm.
06:30 pm.
08:00 pm.
Friday 11:30 am.
12:00 noon
03:30 pm.
05:30 pm.
06:00 pm.
08:00 pm.

10:00 pm.

APPENDIX D

45

Appendix D

Pil overLett -Not n erh

August 15, 1993

To Whom It May Concern,

This is a study being conducted through the Department of Park and Recreation
Resources, Michigan State University. The enclosed packet contains a questionnaire,
stamped return envelope and this letter. The topic of interest for this study is exploring
significant aspects an individual at AA associates with their recovery process. If you are a
recovering alcoholic, we ask that you examine the questionnaire and answer the questions
as complete and honestly as possible. Once the questionnaire has been completed, return
it in the envelope provided. This questionnaire takes approximately 20 minutes to
complete.

In keeping with the traditions and guarantees of AA, your name or identification is not
asked for to insure that your responses will not be able to be connected and your identity
will not be known to the researcher. General information and results of this study can be
obtained by contacting the central AA office. In addition, a write up of the results will be
submitted to a professional journal for publication.

This is a voluntary study. If you choose not to participate, simply dispose of your packet
contents and do not mail your responses back. Thank you in advance for your time,
efi‘ort, and assistance. The information you are providing will hopefirlly lead to a greater
understanding of the recovery process for alcoholics.

Sincerely,

Lisa Parsons

Graduate Student

Department of Park and Recreation Resources
Michigan State University

APPENDIX E

Appendix E

Initi In en
PERCEPTIONS 0F RECOVERING ALCOHOLICS REGARDING THE RECOVERY PROCESS

'I'hefollowingitemsaredesignedtoprovideinformationabouttherecoveryprowssandyourperceptions
ofrecovery. 'I'hisisaconfidentialsurveyinthatatnotimewillyoubcaskedtoidentifyyourselfforthc
purposesofthesnrdy.P1easedonotfilloutthissurveymorethanonetimc. Youranswersandtimeare
mhawrmhwdammnhopemnymdemmemdmmndingofmeaddicfionaMmmvaypmcesses.

SE N 0NE° ATTRIB TI NS INVE RY

PLEASE INDICATE HOW YOU FEEL ABOUT THE STATEMENTS BELOW BY CIRCLING THE
CORRESPONDING NUMBERS ON THE RIGHT-HAND SIDE.

(GI)= Greatly improved my drinking problem (greatly reduced drinking)

(SI)= Slightly improved my drinking probl. (slightly reduced drinking)

(NB)= No bearing, equally helpful or unhelpful, never experienced

(SW)= Made my drinking slightly worse

(MW)= Made my drinking very much worse

GISINBSWMW

l. Wantingnryselfrespect l 2 3 4 5
2. Keepingcompanywithdrinkers l 2 3 4 5
3. Dcterminationnottobebeatenbydrink l 2 3 4 5
4. Puttingtheblameonotherpeople 1 2 3 4 5
5. Whatapsychiatristsaidordid 1 2 3 4 5
6. Finding a drink helps shyness 1 2 3 4 5
7. Decidingmyfatewasinmyownhands l 2 3 4 5
8. Understandingmyselfbetter 1 2 3 4 5
9. Residence in an alcoholism rehabilitation community home 1 2 3 4 5
10. Being lonely 1 2 3 4 5
11.Switchingfromonedrinktoanother 1 2 3 4 5
12.Takinganinterestinotherpeople 1 2 3 4 5
13. Fear ofwhat drinkwas doing to my physical health 1 2 3 4 5
14. Belief inmyhigherpower 1 2 3 4 5
15.Gettingintoanewmarriage 1 2 3 4 5
16. Facinguptoreality 1 2 3 4 5
17.Remindingmysclfofthegoodconsequencesofsobriety l 2 3 4 5
18. Fear ofgoing toprisonthroughdrink 1 2 3 4 5
19.Findingadrinknmdeshakesbet1er l 2 3 4 5
20. Determinationtodrinklikeothers 1 2 3 4 5

47

PLEASE INDICATE HOW YOU FEEL ABOUT THE STATEMENTS BELOW BY CIRCLING THE
CORRESPONDING NUMBERS ON THE RIGHT-HAND SIDE.

(GI)= Greatly improved my drinking problem

(SI)= Slightly improved my drinking problem

(NB)= No bearing, equally helpful or unhelpful, never experienced

(SW)= Made my drinking slightly worse

(MW)= Made my drinking very much worse

GI SI NB SW MW

21. Engaging in recreation activities frequently. 1 2 3 4 5
22. Spouse's real understanding of my problem 1 2 3 4 5
23. Antabuseor Abstem 1 2 3 4 5
24. Gettingoutofa marriage 1 2 3 4 5
25. Admitting to myselfthat I am/was an alcoholic 1 2 3 4 5
26. Stopping feeling sorry for myself 1 2 3 4 5
27. Whatanursesaidordid 1 2 3 4 5
28. Spousethreateningtoleavebecauseofmydrinking 1 2 3 4 5
29.Makingruleonlytodrinkincompany l 2 3 4 5
30.Thoughtsonwhatlcoulddoformyfamilyifsober 1 2 3 4 5
31. Dealing withmyresentments 1 2 3 4 5
32. Keeping out ofbars l 2 3 4 5
33. Increasingmyfreetime l 2 3 4 5
34. Feeling able to give love 1 2 3 4 5
35. Makingsurelnevercarrytoomuehmoney 1 2 3 4 5
36. Spouse getting help for me 1 2 3 4 5
37. Tranquilizers l 2 3 4 5
38. Telling my own story at AA 1 2 3 4 5
39. Out-patient treatment for alcoholism l 2 3 4 5
40.Fearofwhatdrinkingwoulddotomyfamily 1 2 3 4 5
41.Reactionsofmyfriendstomydrinking l 2 3 4 5
42. Spouse'sunhappinessovermydrinking 1 2 3 4 5
43. Learning torelax l 2 3 4 5
44. AA in general 1 2 3 4 5
45. Movingtonewaccommodations 1 2 3 4 5
46.8pousegettingangryovermydrinking l 2 3 4 5
47. ln-patient treatment for alcoholism 1 2 3 4 5
48. Growingupemotionally l 2 3 4 5
49.Fearlwaslosingmymind l 2 3 4 5
50.Workingveryhardatnryjob l 2 3 4 5
51. Gettingthehousespicandspan 1 2 3 4 5
52.Makingsuretherewasnodrinkathome 1 2 3 4 5
53.Whatanactivityorrecreationtherapistsaidordid 1 2 3 4 5
54. Friendship through AA 1 2 3 4 5
55.Reaetionsofotherfamilymemberstomydrinking 1 2 3 4 5
56.Fearoflosingeverythinglhadthroughdrinking 1 2 3 4 5

48

PLEASE INDICATE HOW YOU FEEL ABOUT THE STATEMENTS BELOW BY CIRCLING THE
CORRESPONDING NUMBERS ON THE RIGHT-HAND SIDE.

(GI)= Greatly improved my drinking problem

(SI)= Slightly inrproved my drinking problem

(NB)= No bearing, equally helpful or unhelpful, never experienced

(SW)= Made my drinking slightly worse

(MW)= Made my drinking very much worse

57. Moving to a new district 1 2 3 4 5
58.Whatasocialworkersaidordid 1 2 3 4 5
59. ”rock-bottom"; hitting an absolute low point 1 2 3 4 5
60.Admittingtootherslam/wasanalcoholic l 2 3 4 5
61. Seeing other people's point of view 1 2 3 4 5
62. Fearofbecoming unemployedthroughdrink l 2 3 4 5
63. Being ashamed of my drinking 1 2 3 4 5
64. Interest in activities or recreation 1 2 3 4 5
65. Keeping away from drinking parties 1 2 3 4 5
66. Believing that I could control my drinldng l 2 3 4 5
67. Getting a new job 1 2 3 4 5
68. Always being on guard l 2 3 4 5
69. Worry about alcoholic 'blackouts'- patches of memory loss 1 2 3 4 5
70. Getting over depression 1 2 3 4 5
71. Hearing other people's stories at AA 1 2 3 4 5
72. Reactionsofmy childrentomydrinking l 2 3 4 5

E N ° TI N
THE FOLLOWING ITEMS RELATE TO YOUR PARTICIPATION IN A SUPPORT GROUP

1. HowlonghaveyoubeenattendingAAmeetings? months

2. Howoftendoyouusuallyattendmeetingseachweek?
ONCEAWEEK
TWICEAWEEK
THREETIMESAWEEK
FOURTOSIXTIMESAWEEK
DAILY

3. For how many months have you been seeking support for alcoholism? MONTHS
4. What is the longest period ofabstinence you have been able to maintain?_____months
5. Are you currently a sponsor? __yes _no

6. How long have you sponsored this person(s)?__months ___months ___months
7. How many people total have you sponsored?—

8. What stepareyoucurrentlyworking on? (1-12)

49

9. HAVE YOU EVER COMPLETED A TREATMENT PROGRAM? YES NO

10. How did you find out/become involved with AA?(Explain)

E ON THREE“ EANDRE VER

FOR THIS SECTION, USE THE FOLLOWING DEFINITIONS PROVIDED TO MAKE YOUR
DECISION.

RELAPSE: A RETURN TO THE USE OF A CHEMICAL SUBSTANCE IN WHICH PROGRESSIVE
USE A SUBSTANCE 18 OF THE SAME INTENSITY AS WHEN YOU FIRST SOUGHT TREATMENT
OR ASSISTANCE.

LAPSE: A SHORT PERIOD OF TIME OF USE OF A CHEMICAL SUBSTANCE IN WHICH YOU
USE ON MORE THAN ONE OCCASION BUT EITHER SPONTANEOUSLY RETURN TO
ABSTINENCE OR SEEK TREATMENT OR ASSISTANCE BEFORE YOU RETURNED TO YOUR
PREVIOUS LEVELS OF USE.

SLIP: A ONE TIME USE OF A CHEMICAL SUBSTANCE WITHOUT ANY CONTINUED OR
PROLONGED PERIOD OF USAGE. NOTE YOU CAN HAVE A SERIES OF SLIPS OVER A LONG
SPAN OF TIME. IF IT IS CONSECUTIVE OR A CLUSTERING OF TIME IN A GIVEN PERIOD
THAT WOULD BE A LAPSE VERSUS A SLIP.

I. HAVE YOU EVERY EXPERIENCED A RELAPSE? YES NO .
IF YES, WHICH OF THE FOLLOWING TRIGGERED THE RELAPSE? (YOU MAY CHECK
MORE THAN ONE)

FAMILY WORK/JOB FRIENDS TROUBLE WITH THE
LAW STRESS UNSTRUCTURED BLOCKS OF TIME (FREETIME) NOT GOING TO
MEETINGS REGULARLY NOT KEEPING IN CONT ACT WITH SPONSOR

NOT FOLLOWING SUGGESTIONS IN THE BIG BOOK OTHER (EXPLAIN)

IA. WHAT STEP WERE YOU WORKING ON WHEN THE RELAPSE OCCURRED?
lB. HOW MANY TIMES HAVE YOU EXPERIENCE A RELAPSE?

50

2. HAVE YOU EVERY EXPERIENCED A LAPSE? YES NO_
IF YES, WHAT TRIGGERED THE LAPSE?

FAMILY WORK/JOB FRIENDS TROUBLE WITH THE
LAW STRESS UNSTRUCTURED BLOCKS OF TIME (FREETIME) NOT GOING TO
MEETINGS REGULARLY NOT KEEPING IN CONTACT WITH SPONSOR

> NOT FOLLOWING SUGGESTIONS IN THE BIG BOOK OTHER (EXPLAIN)

2A. WHAT STEP WERE YOU WORKING ON WI~EN THE LAPSE OCCURRED?
2B. HOW MANY TIMES HAVE YOU EXPERIENCE A LAPSE?

 

3. HAVE YOU EVERY EXPERIENCED A SLIP? YES NO
IF YES, WHAT TRIGGERED THE SLIP?
FAMILY WORK/JOB FRIENDS TROUBLE WITH THE
LAW STRESS UNSTRUCTURED BLOCKS OF TIME (FREETIME) NOT GOING TO
MEETINGS REGULARLY NOT KEEPING IN CONTACT WITH SPONSOR

NOT FOLLOWING SUGGESTIONS IN THE BIG BOOK OTHER (EXPLAIN)

3A. WHAT STEP WERE YOU WORKING ON WHEN THIS OCCURRED?
3B. HOW MANY TIMES HAVE YOU EXPERIENCE A SLIP?

4. WHAT DO FEEL IS TI-E MOST IMPORTANT FACIOR IN YOUR SUCCESSFUL RECOVERY?
CI-ECK ONLY ONE.
FAMILY SUPPORT
WORK
STRUCTURED LEISURE OR FREE TIME
YOUR SUPPORT GROUP
A HIGHER POWER
YOURSELF
OT'IER (EXPLAIN)

5. RANK TIE FOLLOWING AS YOU PERCEIVE HOW TI-EY PERTAIN TO YOUR RECOVERY.
l= MOST IMPORTANT 7= LEAST IMPORTANT
FAMILY SUPPORT
WORK
STRUCTURED LEISURE OR FREE TIME
YOUR SUPPORT GROUP
A HIGHER POWER
YOURSELF

OTIER(EXPLAIN)

51

6. WHAT SITUATIONS DO YOU FIND PROBLEMATIC IN YOUR RECOVERY?
RANK ANY AND ALL ITEMS THAT APPLY USING 1 AS MOST PROBLEMATIC

STRESS

CONFLICT

FEELINGS OF LONELINESS

WEEKENDS

FAMILY/SOCIAL EVENTS(BIRTHDAYS, ANNIVERSARIES)
HOLIDAYS (CHRISTMAS, NEW YEARS, 4TH OF JULY)

FRIENDS THAT DO NOT HAVE A DRINKING PROBLEM

BOREDOM

I DON'T FIND ANY SITUATIONS PROBLEMATIC TO MY RECOVERY

OTI-ER (EXPLAIN)

 

 

 

7. BRIEFLY DESCRIBE A SITUATION WITHIN TIE PAST SIX (6) MONTHS IN WHICH YOU
FELT THE TEMP'TATION TO USE? WHAT CAUSED IT?

SE N F ° RECREATION

1. DO YOU CURRENTLY PARTICIPATE IN AN ACTIVITY OR HOBBY? YES NO
2. HOW OFTEN DO YOU PARTICIPATE IN ACTIVITIES OR HOBBES?

ONCE A WEEK

TWICE A WEEK

THREE TIMES A WEEK

FOUR TO SIX TIMES A WEEK

DAILY

3. APPROXIMATELY HOW MANY HOURS A WEEK DO YOU ENGAGE IN RECREATION?
___HRS

4. PLEASE INDICATE YOUR INVOLVEMENT IN ACTIVITIES NOW AS COMPARED TO,
BEFORE ENTERING A TREATMENT PROGRAM
MORE SO THAN BEFORE TREATMENT
SAME AS BEFORE TREATMENT
LESS THAN BEFORE TREATMENT
NEVER ENTERED A TREATMENT PROGRAM

BEFORE BECOMING INVOLVED WITH AA
MORE SO THAN BEFORE AA
SAME AS BEFORE AA
LESS THAN BEFORE AA

5. WHY DO YOU OR DON'T YOU PARTICIPATE IN RECREATION OR LEISURE ACTIVITIES?

 

_a’tuoau - '

52

6. WHAT DOES RECREATION AND LEISURE MEAN TO YOU WITH RESPECT TO YOUR
RECOVERY?

PLEASE EXPLAIN IN YOUR OWN WORDS WHAT IMPACT, IF ANY, RECREATION OR
ACIIVITES HAVE ON YOUR LIFESTYLE AND RECOVERY.

7. HOW DO YOU FEEL ABOUT ACITVITIES WITH RESPECT AID YOUR RECOVERY?
ACTIVITIES ARE IMPORTANT TO MY RECOVER
ACTIVITIES ARE A DISTRACIION TO MY RECOVERY
ACIIVITES ARE NO PART OF MY RECOVERY

SE ION' °BE I 2;; ,'D 0' 0"Y Int“!

INDICATE HOW YOU FEEL ABOUT THE FOLLOWING STATEMENTS TO THE BEST OF
YOUR KNOWLEDGE BY USING THE FOLLOWING KEYS:

1 - STRONGLY 01me 2 - msacm 3 - NO OPINION 4 - AGREE 5- srnonch AGREE

SD D N0 A SA
lamcomfoflable withmycmrentstateofabstinence/sobriety _____
lhaveacceptedthefactthatlamanalcoholic
Ibavealongwaytogobeforelamcured
Iamcontentwithmylifeatthistime _____
Ifeel supported regarding my addiction _____
bymyfamily —————
bymyfriends _____
bymywpportgroup _____

bymyemployet _—_————
Ifeeltbatlcanremainabstinem/sober

Iamembarrassedthatlhaveadrinkingpmblem

I feel the temptation to use alcohol drugs
lwillneverbecuredofmy addiction

1 am uncomfortable around alcohol or places that serve alcohol

My work/job has a lot to do with my sobriety

lwouldnotbesober, ifnotformyfaithinahigherpower
Sinceattendingmeetings, itisokaytogotothcbar

I have no problem keeping in touch with my old drinking buddies
Alcoholism is curable

Myfamilyisalargefactorinmysobriety

A routine physical workout/exerCise is important to me
Alcoholism is controllable
Iamwillingtohelpothersthroughtheirdrinkingproblems

I feel that personal problems might cause me to go back to drinking
Ifeel anxiousabout returningtomypastpatternofdrinking
Iamnotafraidtogoouttosocialgatherings

I have been successful in replacing my drinking with other activities

_—._——

_—_—————

___——-—_

53

My personal relationships have improved since I stopped drinking _____
Iamhappy _____
Mysuppongroupisalargefactorinmysobriety _____
Iamsatisfiedatwork
lofienfeelaneedtomakesuremytimeisstrucnued
Ineedtostructuremytimetoavoidtemptation
Iamsatisfiedinmyleisureorfreetime

lam satisfied with my life
Mywillpowerhasincreasedthmughouttreatmem/meetings
Ifeel that l have control over my addiction

Ifeel that l have control over my recovery
lamsoberbecauseofmyhigherpower
Withoutmysponsoerouldfinditdificulttoremainsober
Mymeetingsarealifelinetomyrecovery

___-__—
—————
__—_—
——-—-—————
——————
——_.-_.—
——_—_
——_—‘
__—_—

SECTION SIX: DEMOGRAng
IDENTIFY YOUR AGE? YRS MALE FEMALE

INDICATE YOUR STATUS.
SINGLE

%

DIVORCED, WIDOWED, SEPARATED

INDICATE WHAT LEVEL OF SCHOOLING YOU HAVE COMPLETED.
SOME HIGH SCHOOL
HIGH SCHOOL DIPLOMA OR G.E.D
SOME COLLEGE
COLLEGE DEGREE

INDICATE YOUR RACE.
BLACK

WHITE

HISPANIC

ASIAN

AMERICAN INDIAN

DO NOT WISH TO RESPOND

l l
i

 

ARE YOU? EMPLOYED
UNEMPLOYED
HOUSEWIFE/HUSBAND
STUDENT
RETIRED
OTIER
DO NOT WISH TO RESPOND

 

 

 

 

HOW DID YOU FIND ms SURVEY?
__OKAY
_EASY TO UNDERSTAND
___TOO LONG
___CONFUSING

 

54

PLEASE MAKE ANY COMMENTS OR SUGGESTIONS YOU HAVE REGARDING THIS SURVEY.
IF THINGS WERE UNCLEAR IN TI-E QUESTIONNAIRE, PLEASE IDENTIFY SO THAT WE CAN
MAKE TIE ITEMS EASIER TO UNDERSTAND.

THANK YOU FOR YOUR TIME AND EFFORTS IN THIS STUDY. ALL COMMENTS ARE
APPRECIATED.

APPENDIX F

55

Appendix F

Study Cover Letter
October 20, 1993
Dear AA Member,

Issues and theories regarding the addictive cycle are constantly being upgraded and explored throughout
the scientific community. However, the majority of studies fail to take YOUR perceptions, as a recovering
alcoholic, into consideration. Treatment centers are faced with the knowledge that only one in thirty
clients who complete treatment will be able to maintain a lifestyle of sobriety. The AA community is one
of the most powerful aflereare and recovery services available to people who suffer from addiction. Your
personal beliefs and experiences may help others to understand the various components of recovery. It is
ourhopethattheywillalsoidenfifykeycomponentsthatneedmbefowsedtmoninueatmentmorderto
helpallthoseindividualswhoarecurrentlyusing

EndosedymwinfindamweymasnidybeingmnmwtedmmghmeDepaimentofParkmd
Recreation Resources, Michigan State University. Thispacketconsists of the survey, astampedreturn
envelopeandthisletter.

What is the purpose of this survey?
This survey will provide information about the significant lifestyle aspects YOU as an AA member
attribute to your recovery program. Your responses will provide information to the therapeutic
community that can help:
1) developamoreroundedandefl'ectivetreatmentpmgram,
2) professionals and recovering alcoholics understand the recovery process better,
3)provide insightintootherareasofreooverythathavenotbeenexploredinpast

Will my name be associated with my answers?
No. All your answers and comments will be completely confidential. Your name will never be placed on
thequestionnaire; ratheryourresponseswillbegroupedwiththoseofabout lOOotherAAmembers.

Howwillmy answersbeused?
Theresmmofmesurveywfllbedissemimwdmmughommemempamcmmmumtymhopesof
providingmoreinsightintotheneedsofrecoveringalcoholics. Asummaryoftheresultswillbe
submitted to a professional journal for publication.

.Ifyouareanalcoholicinrecovery, weaskthatyouexaminethequestionnaireandanswerthequestionsas
completely and honestly as possible. This questionnaire takes less than 30 minutes to complete, then
please return it in the envelope provided We would appreciate the return of the survey by November
30, 1993. Ifyou have any qumions, please feel free to contact me at 131 Natural Resources, Michigan
State University, East Lansing, MI 48824 or call the department omce at (517) 353-5190.

Thankyouforyourtime, efl‘ortandassistance.
Sincerely,

Lisa B. Parsons
Project Leader

APPENDIX G

56

Appendix G

W

The following pages are the actual pages used in developing the questionnaire booklet. In
order to conform to the margin requirements for this paper, the Questionnaire was
reduced. Front and back pages are identified as how the actual pages were numbered.

 

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APPENDIX H

65

Appendix H

Positive Attribute Rankings of 30% Positive Momment or Higher

POSITIVE
RANK ITEM ENDORSEMENT
1 AA in general 100
" Hearing other people's stories at AA 100
3 Believing in a higher power 97
" Telling my own story to others 97
" Finding friends through AA 97
6 Reminding myself of the positive consequences to sobriety 94
" Learning to relax 94
" Admitting to others "I am an alcoholic” 94
9 Taking an interest in other people 93
" Facing up to reality 93
" Growing up emotionally 93
12 Understanding myself better 90
" Admitting to self. "I am an alcoholic” 90
" Stopping feeling sorry for myself 90
" Hitting ”rock bottom”; ultimate low 90
” Seeing other people's point of view 90
17 Wanting my self respect 83
18 Keeping away from drinking parties 81
19 Feeling able to love 74
20 Dealing with my resentments 73
" Fearing that l was losing my mind 73
22 Fearing to lose everything to drinking 68
" Being ashamed of my drinking 68
" Getting over depression 68
25 Being involved in social activities 65
26 Keeping out/away from bars 61
27 Reactions of other family members to my drinking 59
28 Being in a treatment center 58
" Making sure there's no alcohol at home 58
30 Fearing health effects of alcohol 55
" Significant others understanding my problem 55
" Fearing what my drinking would do to my family 55
33 Worrying about alcoholic blackouts 55
” Determination not to be beaten by alcohol 53
35 Working very hard at my job 53
36 Being interested in physical activities 48
37 Fearing unemployment from drinking 47
38 Thinking of what I could do for my family if sober 45
39 Deciding my fate was in my own hands 42
" Entering into a new relationship 42
" Fearing prison due to drinking 42
" F riend's reaction to my drinking 42
43 Talking to a psychiatrist 39
" Engaging in Recreation activities 39
45 Increasing my free time 35
46 Always being on guard 32

- ‘J-lllfl’v' a -r

 

 

APPENDIX I

Appendix I

Negative Attribute Rankings of 20% Negative Endorsement or Higher

NEGATIVE
RANK ITEM ENDORSEMENT
] Being or feeling lonely 9O
" Hitting "rock bottom"; ultimate low 90
3 Believing I could control my drinking 87
4 Blaming others for my problems 81
" Keeping away from drinking parties 81
6 Determination to drink like others 77
7 Switching from one kind of drink to another 74
8 Using alcohol to be less shy 71
9 Finding a drink made my shakes better 58
10 Always being on guard 52
1 1 Increasing my free time 42
12 Deciding my fate was in my own hands 35
" Engaging in recreation activities 35
14 Getting over depression 29
15 Being ashamed of my drinking 26
16 Worrying about alcoholic blackouts 23
" Working very hard at my job 23
" Making rule to drink only in company 23
" Significant other getting angry over my drinking 23
" Using tranquilizers 23
" Getting out of a relationship 23
" Dealing with my resentments 23
23 Reactions of other family members to my drinking 2]

24 Fearing unemployment from drinking 20

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67

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