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The role of AA sponsors: A pilot study

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The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors. Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors' responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS). Sample characteristics were as follows: the median length of AA attendance was 9.5 years (range 5-28); the median length of sobriety was 11 years (range 4.5-28); the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9). Past alcohol dependence scores were surprisingly low: 5 (18%) sponsors had mild, 14 (50%) moderate and 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56). Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis: (1) encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity); (2) support (regular contact, emotional support and practical support); and (3) carrying the message of AA (sharing sponsor's personal experience of recovery with sponsees). The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.
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Alcohol & Alcoholism Vol. 44, No. 4, pp. 416–422, 2009 doi: 10.1093/alcalc/agp014
Advance Access publication 18 March 2009
TREATMENT
The Role of AA Sponsors: A Pilot Study
Paul J. P. Whelan1,, E. Jane Marshall2, David M. Ball3and Keith Humphreys4
1Central and North West London NHS Foundation Trust, North Westminster Older Adults Community Mental Health Team, Latimer House, 40 Hanson Street,
London W1W 6UL, UK, 2South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London, Box 048, De Crespigny Park,
London SE5 8AF, UK, 3Institute of Psychiatry, King’s College London and South London and Maudsley NHS Foundation Trust, Box P082, De Crespigny Park,
London SE5 8AF, UK and 4Department of Psychiatry, Stanford School of Medicine, 401 North Quarry Road, Room C-305, Stanford, CA 94305-5717, USA
Corresponding author: Central and North West London NHS Foundation Trust, North Westminster Older Adults Community Mental Health Team, Latimer
House, 40 Hanson Street, London W1W 6UL, UK. Tel: +44-207-6121672; Fax: +44-207-6370545; E-mail: paul.whelan@nhs.net
(Received 11 December 2008; first review notified 21 January 2009; in revised form 21 February 2009; accepted 24 February 2009;
advance access publication 18 March 2009)
Abstract — Aims: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the
characteristics of a sample of sponsors. Methods: Twenty-eight AA sponsors, recruited using a purposive sampling method, were
administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis
of sponsors’ responses; Severity of Alcohol Dependence Questionnaire—Community version (SADQ-C) and Alcoholics Anonymous
Affiliation Scale (AAAS). Results: Sample characteristics were as follows: the median length of AA attendance was 9.5 years (range
5–28); the median length of sobriety was 11 years (range 4.5–28); the median number of sponsees per sponsor was 1 but there was a
wide range (0–17, interquartile range 3.75); and the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5–8.75,
maximum possible score 9). Past alcohol dependence scores were surprisingly low: 5 (18%) sponsors had mild, 14 (50%) moderate
and 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11–56). Sponsorship roles were as follows: 16 roles
were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis: (1)
encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity); (2) support (regular contact,
emotional support and practical support); and (3) carrying the message of AA (sharing sponsor’s personal experience of recovery with
sponsees). Conclusions: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This
non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.
INTRODUCTION
Alcoholics Anonymous (AA), as a whole, has been well re-
searched. Although it is not a ‘treatment’ per se, a number of
studies have shown that participation in AA activity is asso-
ciated with a reduction in drinking, increased sobriety and an
improved quality of life (Tonigan et al., 1996; Timko et al.,
2006). The principles of AA are disseminated in an iterative
fashion during meetings and via AA literature. However, spon-
sors play an important role as well. Sponsors are established
members of the fellowship, who have been sober for a substan-
tial period and have applied the principles of the AA programme
to their own lives. They mentor other members, give advice and
support, and assist them in completing the 12 steps (Chappel,
1994). Sponsors help both new and other established members
of AA, but the support provided to ‘newcomers’ is given special
importance in the fellowship. Little is known about sponsors,
as few studies have focused on them, and none on their roles.
At the inception of AA, there were no official sponsors. In
fact, sponsorship is not mentioned in the fellowship’s original
text, the Big Book (Alcoholics Anonymous, 1935). However,
the support and help that AA’s founder, Bill Wilson—himself
only a few months sober at the time—gave to Dr Bob Smith, the
fellowship’s co-founder, is described as the first act of sponsor-
ing in the AA pamphlet Questions and Answers on Sponsorship
(Alcoholics Anonymous, 2005). In this booklet, a sponsor is
defined as ‘an alcoholic who has made some progress in the
recovery program and shares that experience on a continuous,
individual basis with another alcoholic who is attempting to at-
tain or maintain sobriety through AA’. The roles of a sponsor,
as delineated in this pamphlet, are summarized below:
rA sponsor does everything possible, within the limits of
personal experience and knowledge, to help the newcomer
get sober and stay sober through the AA programme.
rThey field any questions the new member may have about
AA.
rSponsorship gives the newcomer an understanding, sym-
pathetic friend when one is needed most—it assures them
that at least one person cares.
Sponsorship is considered to be a mutually beneficial affair:
the sponsee benefits from the practical and emotional support
of a more senior member of AA, but the sponsor also maintains
their sobriety through helping others (Chappel, 1994). This lat-
ter factor is supported by findings from the Project MATCH
trial that showed that recovering alcoholics who help other
alcoholics maintain sobriety were significantly less likely to
relapse themselves (Pagano et al., 2004). There is an evolv-
ing literature about helping behaviour in recovering alcoholics
and various helping scales have been developed (Zemore and
Kaskutas, 2004; Kaskutas et al., 2007). Although there are ar-
eas of overlap, this literature does not focus specifically on
sponsorship—helping behaviour is arguably only one of the
roles of a sponsor, and many AA members who are not spon-
sors engage in helping behaviour.
The aim of this study was to explore how sponsors view
their roles in helping sponsees. In the absence of scientific
data relating to this aspect of sponsoring behaviour, the study
reported here represents a preliminary primarily qualitative ex-
ploration of the opinions of a specifically recruited sample of
sponsors about their roles with a view to developing more com-
plex research questions for a subsequent study of this important
C
The Author 2009. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved
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The Role of AA Sponsors 417
AA activity. In addition, the characteristics of the sample of
sponsors are described in terms of their affiliation to AA, past
drinking and severity of dependence on alcohol.
METHODS
Inclusion criteria
To be included in the study, participants needed to be a sponsor
or to have previously been a sponsor, to have ‘worked’ the
programme of AA (have completed the 12 steps and regularly
attend meetings) and to be sober.
Sampling method
A purposive sampling (Tronchim, 2006) method was used in
keeping with the primarily qualitative approach adopted by the
study. Purposive sampling targets a particular group of people
(in this case AA sponsors) and is a useful method when the
desired population for the study is rare or very difficult to
locate and recruit for a study. According to the 2007 North
American AA membership survey, 80% of attendees have a
sponsor (Alcoholics Anonymous, 2008). However, there are no
data available about the proportion of sponsors in AA (personal
communication, Alcoholics Anonymous).
Recruitment
Sponsors were recruited from five ‘open’ AA meetings (i.e.
meetings that are open to all attendees and not just those seek-
ing recovery from alcoholism) in central London. Anticipating
a 15–20% drop-out rate, we initially recruited 36 AA sponsors
with the aim of achieving a sample of 30 sponsors. This num-
ber was decided upon following discussion with qualitative
researchers in the addiction field who advised that sufficient
data would be gathered from this number of participants to
guide the research questions for the second phase of this study.
Data collection
In order to facilitate participation, the sponsors were offered
flexibility in completing the research questionnaire: completing
it by hand and returning it by post; completing by email; or by
telephone interview. The questionnaire comprised two existing
validated scales, as well as a number of questions specifically
designed to elicit data pertinent to the aims of this study. The
Alcoholics Anonymous Affiliation Scale (AAAS) was used to
measure the degree of involvement in AA. Its utility in a sam-
ple of 927 alcohol treatment seekers and 674 untreated problem
drinkers has previously been demonstrated (Humphreys et al.,
1998). The scale is short (nine items), covers a range of AA
experiences and is internally consistent across diverse demo-
graphic groups, multiple health services settings, and treated
and untreated populations. The AAAS has been widely used
both as an interviewer-administered instrument and self-report
questionnaire.
The Severity of Alcohol Dependence Questionnaire—
Community version (SADQ-C) was administered as a
retrospective measure of impaired control over drinking
(Stockwell et al., 1994). The SADQ-C was designed for com-
munity samples and it correlates almost perfectly (r=0.98)
with the SADQ. A score of <16 indicates mild dependence,
16–30 moderate and >30 severe dependence. The SADQ-C
was slightly adapted for the purpose of this study to measure
severity of alcohol dependence retrospectively by requesting
the sponsors to answer the questions in relation to the heaviest
period of their drinking career.
In another section of the questionnaire, the respondents were
asked about what they see as their sponsorship roles. The ques-
tion was kept simple and left open without probes; this approach
that was used as the aim of the study was to gather prelimi-
nary data regarding sponsorship roles to help formulate more
complex research questions for the next phase of the study (in-
volving face-to-face interviews/focus groups with a sample of
sponsors).
Data analysis
No specific hypothesis was tested in the study, as few data exist
in the scientific literature regarding sponsorship. As such, a
grounded theory approach (Glaser and Strauss, 1976) was used
for collecting and handling data relating to sponsors’ views of
their role, i.e. a theory generating rather than hypothesis testing
method was used.
As data were gathered by different means (i.e. self-
completion of the questionnaire or telephone interview), they
were initially collated into a standardized format. Responses
were separated into statements and coded line-by-line so
that emerging themes could be identified. All roles identi-
fied through this analysis were listed. Thereafter, overlapping
themes were linked by identifying common nodes (points of
connection) and were reported as super-ordinate roles. A tri-
angulation method was applied to the thematic analysis: a col-
league of the first author conducted an independent content
analysis of the responses, and any points of disagreement were
discussed. When disagreement persisted with regard to individ-
ual sponsors’ responses, they were contacted again to clarify
what they meant in the given response. Finally, a member val-
idation method was used—the research report was sent to two
selected sponsors and amendments were made based on their
comments.
RESULTS
Sample characteristics
Thirty-eight sponsors were approached. Two did not meet the
eligibility criteria (one was currently drinking and another was
not regularly attending AA). Thirty-six sponsors who initially
agreed to consider participation were sent the study’s intro-
duction pack. Eight sponsors failed to respond following two
attempts to contact them via an invitation letter, email or tele-
phone call. Thus, a total of 28 sponsors completed the question-
naire or interview (21 by email, 6 by post and 1 via telephone
interview).
As this was primarily a qualitative study, random sampling
was not used. We were cautious when interpreting descrip-
tive and analytical statistics, as the sponsors included may not
be a representative group. Twenty-four (86%) male and four
(14%) female sponsors participated. The median age was 43
[interquartile range (IQR) 17, range 33–73]. Nineteen respon-
dents were white British (68%), two (25%) were non-white
British and seven white non-British (four Americans, two Irish
and one South African). With regard to employment status, six
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418 Whelan et al.
Fig. 1. The average daily consumption of alcohol (UK units) by sponsors at
the peak of their drinking.
(21%) sponsors worked in a managerial capacity, nine (33%)
were professionals, seven (25%) were self-employed and two
(7%) worked in sales. Three sponsors (10%) were retired and
only one was unemployed.
AA activity and sponsoring behaviour
The median length of AA attendance was 9.5 years (range
5–28). There was a wide range (0–17, IQR 3.75) in terms of
the number of current sponsees but the median was 1. Eleven
sponsors (39%) had no current sponsees whereas one sponsor
had 17, more than twice as many as the next highest number.
The sponsors scored highly on the AAAS (median 8.75,
range 5.5–8.75, maximum possible score is 9) indicating strong
AA affiliation and activity. To put this in context, a previous
study reported a mean AAAS score of 2.96 (SD 2.49) in a
sample of treatment receiving problem drinkers and a score of
only 0.43 (SD 1.4) in a community dwelling sample of problem
drinkers (Humphreys et al., 1998).
Past drinking behaviour
The median length of sobriety of the sample was 11 years
(IQR 8.6, range 4.5–28) and the mean was 13.3 years (SD 6.6).
The length of sobriety was highly correlated with the sponsor’s
length of AA attendance (r=0.81, P=0.01).
Alcohol consumption
Seven sponsors (25%) reported that they had been binge
drinkers at the peak of their drinking, 10 (36%) had been daily
drinkers and a further 10 (36%) reported both patterns at dif-
ferent times at the peak of their drinking. One sponsor did not
answer this question. Figure 1 shows the average consumption
of alcohol (UK units) per day at the peak of the sponsors’ drink-
ing (median 12, IQR 20, range 10–70; mean 31.6, SD 16.3).
The median duration of heavy drinking was 12 years (IQR 14,
range 3–27).
Severity of dependence
The median past severity of alcohol dependence score as mea-
sured by the SADQ-C was 26.5 (IQR 14, range 11–56) and
the mean score was 27.4 (SD 1.7). Five sponsors (18%) had
Lower-order roles
(% respondents)
Super-ordinate
roles
1. Availability (29)
2. Non-judgmental (18)
3. Friendship (18)
4. Confidant (11)
5. Answer AA questions (11)
6. Offer hope (7)
7. Take to meetings (7)
8. Help achieve sobriety (7)
9. Identify risky behaviors (4)
e.g. going to bars
Working
Programme
12 steps
Meetings
Service
Carrying AA
Message
Advice
Fidelity of message
Support
Regular contact
Emotional support
Practical support
10. Guide through 12 steps (64)
11. Encourage AA activity (36)
Steps
Service
Helping others
Increase sponsee’s
motivation
12. Discuss spiritual matters (4)
13. Sharing experience of
recovery with sponsee (46)
14. Advice giving (40)
15. Pass on AA message (11)
16. Avoid fundamentalism (11)
Fig. 2. Sponsoring roles identified by thematic analysis of sponsors’ responses.
mild dependence, 14 (50%) had moderate and 9 (32%) had se-
vere dependence. The sponsors’ median scores for the SADQ-
C subscales, which have a maximum possible score of 12,
were as follows: physical withdrawal symptoms (4, IQR 4);
relief drinking (4, IQR 3); alcohol consumption (5, IQR 3.75)
and rapidity of reinstatement subscales (5, IQR 4), indicating
mild to moderate severity in those domains. However, scores
for affective withdrawal symptoms were higher (median 9,
IQR 5).
Sponsorship roles
Sixteen sponsorship roles were identified through the initial
content analysis. These are listed in Figure 2, ranked by fre-
quency of response. Data saturation occurred after sponsor 25,
i.e. no new roles were identified during the analysis of the
last three questionnaires. The degree of agreement between the
two coders was good (kappa =0.8). Three super-ordinate roles
were created by categorizing the roles identified during the ini-
tial analysis into themes by linking nodes in common. These
roles, working the programme of AA, support, and carrying the
message of AA, will be discussed in turn.
Working the programme of AA
The most important role of a sponsor is to encourage their
sponsee(s) to work the programme of AA, which comprises
the following core activities.
Completing the 12 steps. The sponsors were of the view that
the steps should be completed in the order they are written and
should be applied to all aspects of life (not just alcohol-related
ones) or, as it says in AA literature, ‘in all our affairs’.
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The Role of AA Sponsors 419
The most important thing is taking [sponsees] through the steps,
not telling them how to do them but what the meaning behind
them is. This involves reading [AA literature], discussing and
understanding. (sponsor 12, male, 73 years old)
Regular attendance at AA meetings. The sponsors regarded
encouraging their sponsees to attend meetings as one of their
main roles. However, none commented specifically on how
often they thought that their sponsees should attend meetings.
The mean number of meetings the sponsors themselves had
attended in the previous year was 121 (SD 66, range 20–300),
an average of just over 2 per week.
Doing AA service. Doing service is voluntary but it is embed-
ded in AA culture and is considered helpful both to the recovery
of the individual member and to AA as a whole. Service posi-
tions include being involved in the running of a meeting (e.g.
being a greeter, making tea or being the secretary) and/or be-
ing involved in the functioning of AA as an organization (e.g.
manning the telephone at an AA call centre).
Support
The second most common super-ordinate role was support giv-
ing. The two main mechanisms for providing support were
speaking regularly with the sponsee by telephone and in per-
son, usually in the sponsor’s home or in a caf´
e. The face-to-
face meetings often occur in the sponsor’s home if formal ‘step
work’ is being undertaken or in a caf´
e/at an AA meeting if
the sponsor and sponsee are meeting about other matters. The
support offered by sponsors can be broken down into two broad
types. The first is of an emotional nature, which is especially
important in the sponsee’s early days of recovery and during
periods of difficult life events, such as a divorce.
To offer empathy and support through difficult times, helping
the person to know that they are not alone. (sponsor 16, male,
34 years old)
Secondly, practical support is provided around AA-related
issues. This ties in with the previous super-ordinate role of
working the programme of AA. A number of sponsors rec-
ognized that sponsees may have issues that were not directly
related to AA, such as co-morbid mental health problems, and
indicated that they would encourage their sponsee to seek help
from other appropriate sources outside of AA, such as a doctor
or a counsellor, if they had done so themselves.
I think it is important to note that a skilful sponsor will also
know when to recognize that a sponsee has problems outside
their own sphere of experience and encourage the sponsee to get
help from another source if required. This may be another AA
member or help outside of AA if required. (sponsor 21, male,
39 years old)
Another theme to emerge from the data was that AA meetings
were not an appropriate environment to share problems of a
particularly personal nature, for example sexual problems. A
benefit of sponsorship is that such issues can be discussed in a
more confidential way. This is in keeping with the AA literature,
which suggests that sharing in a meeting should be kept general
and should relate to alcoholism and/or recovery.
The need to develop their sponsee’s trust was an important
role identified by the sponsors. This connected with the lower-
order theme of being non-judgmental. The fact that the spon-
sor is not a professional person and is a recovering alcoholic
increases identification, and a sense that the sponsor has ‘been
there’ too.
Be accepting—tell the guy he’s not alone, try to reassure him
that he is not more than an averagely ‘bad’ person, i.e. share my
experience. Tell him I’ve done that too. (sponsor 20, male, 42
years old)
Finally, a number of participants recognized that the role
of sponsorship changed over time as the sponsee developed a
longer period of sobriety, often growing into a genuine friend-
ship. Five sponsors identified friendship as a primary role.
Carrying the message of AA
Arguably one of the most interesting, if contentious, themes
to emerge from the analysis related to the ‘passing on’ of the
message of AA from the sponsor to the sponsee. According to
the AA literature, this involves sponsors sharing their experi-
ence of alcoholism and recovery with their sponsees, but doing
so within the framework of AA principles rather than adopting
a personal viewpoint. The concept of propagating AA for the
benefit of other alcoholics is embedded in the final step of the
programme, step 12, i.e. having completed and benefited from
doing the 12 steps themselves, an AA member should carry the
message of the fellowship to other alcoholics and AA newcom-
ers through service. Although not a requisite of the final step,
the AA member may, in turn, become a sponsor.
Carrying the message included the lower-order role of advice
giving. As might be expected, a sponsor relating their own
experience of recovery and doing the programme of AA will
often venture into the territory of giving advice to a sponsee, or
a sponsee will seek their sponsor’s opinion on an issue. The role
of advice giving was the only theme for which differing, and
sometimes contradictory, responses were provided by sponsors.
The various viewpoints taken by sponsors in the domain of
advice giving are described in Table 1.
A number of sponsors were of the view that the message of
AA should be delivered gently to sponsees. It seems that within
the various subcultures that exist in AA, some members can be
quite harsh with newcomers and some sponsors are perceived
as ‘controlling’ by their sponsees. One member admitted to
having been a controlling sponsor initially but now recognized
that this was the wrong approach.
When I came in [to AA], I was very much a ‘step Nazi’. I
told everyone exactly what to do and fired them [i.e. stopped
sponsoring them] if they didn’t do what I said. (sponsor 14,
male, 70 years old)
DISCUSSION
Representativeness of the sample
Despite the use of a non-random sampling method, the sponsors
were representative of AA members in general in terms of age
and ethnicity. However, there were fewer women in this study
than in AA as a whole (14% versus 35%) and the sponsors
were from higher socio-economic backgrounds (as determined
by occupation) than those in the 2007 AA membership survey.
Whether the sample is representative of AA sponsors as a whole
is unknown as there are no previous studies describing the
characteristics of sponsors. Caution is needed in interpreting
these comparative data as the AA membership survey covers
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420 Whelan et al.
members in North America only and our sample comprised UK
sponsors.
The number of sponsees per sponsor
The number of sponsors who had active sponsees was lower
than we expected. The average number was one per sponsor
but there was a wide range (0–17). Despite the fact that all the
respondents had been a sponsor in the past, 11 had no current
sponsee (this was, in fact, the modal number). No data exist
about the number of sponsors in AA (personal communication,
Alcoholics Anonymous), but the AA membership survey of
2007 indicated that 80% of members had a sponsor. It is prob-
able though that there are fewer sponsors than sponsees. In
addition, it is likely that sponsees change sponsors over time,
which may account for the low number of currently active
sponsors in this sample.
Severity of alcohol dependence
The average severity of past alcohol dependence of the sam-
ple was less than we expected. Only 32% of the sponsors had
been severely alcohol dependent. This is arguably lower than
National Health Service alcohol treatment samples in the UK.
For example, in a study by Harris et al. (2003), 63% of patients
undergoing an inpatient alcohol detoxification, who had also
attended at least one AA meeting previously, were severely al-
cohol dependent according to their SADQ scores. There are a
number of potential explanations for this discrepancy. First, we
did not ask whether the sponsors had ever received treatment
for alcoholism and it is unfair to compare a treatment sample,
especially an inpatient detoxification one, with a community
sample. In addition to this, there was heterogeneity within the
sample with some sponsors scoring highly on the SADQ-C
(three scored >50, indicating very severe dependence). Sec-
ond, it might be that individuals with more social capital (the
sponsors were from high socio-economic backgrounds) have
shorter drinking careers (they seek treatment earlier than their
counterparts from lower socio-economic backgrounds) and are,
thus, less severely alcohol dependent and have a greater likeli-
hood of becoming sponsors if they join AA.
High affective withdrawal symptoms scores
Another interesting finding relates to the sponsors’ subscale
scores. The sponsors obtained high scores on the SADQ-C
affective withdrawal symptoms’ subscale but relatively low
scores on the other domains. The reason for this is unclear.
However, it was the first researcher’s impression from attend-
ing meetings that AA members’ affective responses to diffi-
culties, be they day-to-day hassles (e.g. commuting to work)
or interpersonal problems, were often intense. It is possible
that AA members have unusually strong affective responses to
life events, and this may be one explanation for the need for
ongoing support through meetings. King et al. (2003) found
this to be the case for female, but not male, non-AA-attending
alcoholics.
Sponsorship roles
The lower-order sponsorship roles identified comprised a com-
bination of functions that are unique to 12-step fellowships,
such as encouraging sponsees to do the steps, and others
that are common to professional interventions. For example,
Table 1. Various viewpoints of sponsors regarding advice giving to sponsees
Viewpoint Respondents (%) Comment
Guidance rather
than advicea
37 Gently guide sponsee within
the framework of AA
principles rather than
telling them what to do
Experience rather
than opinionsa
25 Restricting discussions to
sponsor’s own experience
of alcoholism/recovery
means that they relate facts
rather than opinions to
their sponsees. This
prevents sponsors from
giving potentially harmful
advice to their sponsees
Limited advice 11 Advice only given when
sponsee asks for it
Advice on life
issuesb
22 Giving advice to sponsees
about life issues rather than
just sharing their
experience of
recovery/AA-related
matters
aIn keeping with AA principles; bNot keeping with AA principles.
concepts such as being non-judgmental and the instillation of
hope are well established in the general psychotherapy liter-
ature, and increasing motivation to achieve/maintain sobriety
and identifying behaviours that put sobriety at risk are ubiqui-
tous in the addiction field.
There was considerable overlap between the various themes
identified from the sponsors’ responses. However, it was pos-
sible to categorize the roles into three superordinate roles—
working the programme of AA, support giving, and carrying
the message of AA. These broadly matched the meta-themes
described in the AA pamphlet, Questions and Answers on
Sponsorship, viz. achieving sobriety through working the pro-
gramme, answering AA-related questions outside of meetings
and friendship. Our sponsors placed less emphasis on the role
of helping sponsees achieve sobriety with only one sponsor
identifying this as a specific role. It could be that attempting to
achieve sobriety is ‘given’ in AA and the sponsors did not feel
the need to mention this as a specific role. The sponsors who
did highlight sobriety as a role focused on maintenance (e.g.
advising sponsees to avoid ‘wet places’) rather than achieving
sobriety. Only one sponsor directly mentioned Questions and
Answers on Sponsorship, which is interesting as this is the main
AA document dealing with the issue of sponsorship.
Fidelity of the AA message and the role of advice giving
The sponsors broadly agreed on the first two super-ordinate
roles, i.e. working the programme and support giving. The
theme of carrying the message of AA was the only one for which
differing responses were given by the sponsors. However, most
sponsors agreed that carrying the message of recovery should
be in keeping with AA principles.
The issue of fidelity of AA principles is directly connected
to the role of advice giving (Table 1). The sponsors in this study
can be divided into three groups based on their attitude to advice
giving: those who do not give advice at all; those who advise
in certain circumstances; and those who give advice freely.
Sponsors who do not give advice directly use the mechanism
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The Role of AA Sponsors 421
of describing or sharing their personal experience of recovery
as a way of guiding sponsees rather than telling them what to
do. This approach is most in keeping with AA principles.
AA guidance may be applied in a straightforward fashion
when it relates to sobriety. The message for sponsees is clear:
do not drink, go to meetings and work the programme of AA.
However, a number of sponsors recognized that their sponsees
often needed help in areas of their lives other than in main-
taining sobriety. In these circumstances, some sponsors were
prepared to advise as long as the advice was either sought by
their sponsee or it was given within the principles of AA. This
seems to be a reasonable approach and not contradictory to AA
guidance.
A small subset of sponsors admitted to freely giving advice
to sponsees. This is not in keeping with the principles of AA
and is not without risk. AA states clearly in its 12 traditions that
it is not a professional organization and does not have views
‘on outside matters’ (i.e. issues not directly related to alco-
holism/recovery) (Alcoholics Anonymous, 1976). In addition
to its protective properties, not giving direct advice potentially
increases the motivation of sponsees to remain sober and en-
gage in the programme of AA. A comparison may be made
with motivational interviewing, in which the professional de-
livering the therapy develops discrepancy between the drinker’s
life intentions and their use of alcohol, rather than by directly
telling them what to do.
Controlling behaviour by sponsors
The matter of advice giving may relate to the extent to which
some sponsors wish to impose their will on their sponsees. A
number of sponsors referred to what could be loosely described
as their controlling behaviour, often recognizing that it is un-
helpful. Sponsor 14 even referred to himself as a ‘step Nazi’.
The term ‘controlling behaviour’ is not well described in the
psychiatric literature and is, perhaps, a lay term. However, AA
literature refers to this type of behaviour as ‘self-will run riot’,
which it believes to be at the core of ‘the disease’ of alcoholism.
AA has devised an elegant antidote to issues relating to
self-will—the steps. It is interesting that only step 1 mentions
alcohol. All the others are about dealing with life, as well
as managing the non-drinking aspects of ‘alcoholism’ and
psycho-emotional problems (‘character defects’). The concept
of spirituality or a ‘higher power’ is embedded within the steps.
The related idea of ‘letting go’ may be one of AA’s greatest
techniques in dealing with control issues. Recent developments
in psychology have mirrored this. Kabat-Zinn and colleagues
have successfully married cognitive-behavioural therapy
(CBT) and mindfulness meditation (a type of Buddhist med-
itation) in treating depression, anxiety and other psychiatric
disorders (Kabat-Zinn et al., 1992; Teasdale et al., 2000).
Unlike traditional cognitive therapy, mindfulness-based CBT
uses techniques, learned through meditation, to avoid engaging
(i.e. ‘letting go’) in negative thoughts and other cognitive
errors rather than trying to challenge them, the process of
which can actually cause more distress to some clients.
Implications for services
Given that the majority of AA members have a sponsor, it
is important that professionals working in the addiction field
have an appreciation of the function of sponsors. The ‘buddy
system’ has been used in the treatment of alcoholics for over 40
years (Androes and Whitehead, 1966), and its efficacy has been
shown in the treatment of smokers (West et al., 1998). However,
it is important to distinguish a ‘buddy’ from a sponsor. The
former involves a professional, linking one of their clients with
an AA member for support during a period of introduction to
the fellowship, whereas to obtain a sponsor an AA member
needs to approach another member directly at a meeting and
ask them to be their sponsor. There may be subtle differences
(e.g. in terms of motivation) between the two. In addition, a
sponsor is arguably more likely to be strongly affiliated to AA
than a buddy, who may not necessarily be a sponsor.
Limitations
The study has two main limitations. First, the non-random sam-
pling strategy may have resulted in unrepresentative sample
of sponsors. Exacerbating this potential problem with gener-
alizability, the lead author’s gender (male) and social class
(professional) may have accounted, in part, for the under-
representation of women and the over-representation of spon-
sors from a professional background.
Second, the SADQ-C was used as a retrospective measure.
The median length of sobriety of the sponsors was 11 years
giving rise to the possibility that recall bias may have influ-
enced the SADQ-C scores—this may account for the relative
difference in the subscale scores, with affective withdrawal
symptoms being remembered more than physical symptoms.
In addition, the first limitation may have led to the recruitment
of sponsors who were less severely alcohol dependent.
Future directions
This study represents a pilot study used to formulate further
research questions about sponsorship roles. In depth face-to-
face interviews and focus groups will be conducted during the
second phase of the study, which will use this sample of spon-
sors (plus additional sponsors recruited through a snowballing
technique). The data generated by this study will be used to
develop the probes that will be used during the interviews and
focus groups so that a more complex understanding of spon-
sorship roles and behaviour can be achieved.
There are a number of issues that will be addressed in the
subsequent study. First, we plan to explore how members learn
how to sponsor. Second, the issue of so-called ‘controlling be-
haviour’ within AA merits further examination. Such behaviour
may be linked to sponsorship style—some sponsors adopt a
more authoritarian approach (‘step Nazi’) whilst others have
a more relaxed style. Sponsees may respond in a differential
fashion to sponsorship style. It is also possible that the same
sponsee benefits from a different sponsorship style at differ-
ent points in recovery, for example early versus later sobriety.
To what extent and for what reasons do AA members change
their sponsors over time, and does such change reflect a per-
ceived need to tailor sponsorship style will be addressed in the
subsequent study.
Finally, each of the sponsorship roles will be examined in
greater detail with a particular exploration of the divergent
views regarding advice giving that were reported in this study,
as well as looking at other roles that were not emphasized (e.g.
the need for members to have a ‘home group’ meeting).
by guest on December 26, 2015Downloaded from
422 Whelan et al.
We were fortunate to be able to develop trustful relations
with the sponsors recruited in this study. However, AA can
sometimes be wary of professional involvement so we would
advise others to consider conducting similar research to proceed
carefully. We found attending ‘open’ meetings useful in this
regard. Details of local ‘open’ meetings can be determined by
telephoning the AA National Helpline (0845-769-7555 in the
UK).
Acknowledgements — The authors would like to express their gratitude to Prof Griffith
Edwards and Ms Samantha Gross (both at the Institute of Psychiatry, King’s College
London) for their help with the design and implementation of the study. The authors
would also like to thank the sponsors who took part in the study for their time and helpful
comments. The study was approved by the College Research Ethics Committee of King’s
College London (CREC/07/08-103).
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... For instance, in contrast to professional clinicians, AA sponsors can be considered "wounded healers", with their "own suffering and vulnerability" (Jackson, 2001) at the forefront when attempting to help other AA members. Drawing on their lived experiences rather than professional CHAPTER 1 24 expertise, AA sponsors have been found to provide empathy, emotional support, and practical guidance that can be particularly valuable in helping individuals navigate their recoveries (Whelan, Marshall, Ball, & Humphreys, 2009). Further, AA's peer-to-peer structure offers a sense of belonging that has been consistently emphasised by members in both AA texts and academic publications (AA, 2001, p. 276;. ...
Thesis
Full-text available
Introduction Alcoholics Anonymous (AA) is an international mutual aid/peer-to-peer organisation designed to support anyone who wants to stop drinking alcohol. It is well-established that AA membership typically involves the adoption of a distinct “alcoholic” identity, with new members generally learning that they have no control over alcohol and need to perform specific AA-recommended actions to remain abstinent. Studies have demonstrated that the adoption of AA’s prototypical “alcoholic” identity can be an effective means of maintaining abstinence and improving overall wellbeing. However, critics have denounced AA for propagating a highly prescriptive narrative to understand the nature of problematic alcohol use and recovery. AA has also been frequently criticised for being underpinned by an outdated medical model of “alcoholism” and Christian ideology. Given the organisation’s contentiousness, there is a need for balanced research that considers and integrates the perspectives of both its defenders and critics. To better understand AA’s strengths and weaknesses, the overarching objective of this thesis was to critically explore varied individual experiences in AA. In particular, this thesis aimed to investigate the processes and outcomes of negotiating group membership in AA, including accepting, resisting, and/or rejecting AA ideology and practices. Methods To collate and critique the existing literature base, a systematic literature search and critical review of 21 qualitative interview studies with AA members was conducted (Chapter 2). Interviews with 11 ex-members of AA were then examined using an interactionist conception of “social career” involving conversion and deconversion as a guiding theoretical framework, exploring their experiences of integrating into AA and the reasons why they ultimately rejected AA ideology and practices (Chapter 3). Interviews with 15 AA members were interpreted with a “politics of belonging” theoretical lens, identifying the aspects of AA ideology and practices that were negotiable, as well as those that had to be adopted entirely to belong comfortably (Chapter 4). Finally, 19 prospective interviews conducted over 12-18 months examined the experiences of six AA members and were analysed using a “master narrative” theoretical perspective, highlighting both the benefits and costs of adopting AA ideology and practices (Chapter 5). Results The systematic review (Chapter 2) found that past qualitative interview studies in this field have mostly reported the positive experiences of members who had accepted AA ideology and practices. Common themes across the reviewed studies included that “alcoholics” are “powerless” over alcohol, need to hit “rock bottom” to achieve abstinence, and undergo positive personal changes as a result of their AA involvement. Results highlighted several issues with the methodological quality of the reviewed articles, including a lack of critical positioning in introductory literature reviews or researcher positionality statements. Prominent findings across the empirical studies (Chapters 3-5) related to members’ varied experiences accepting, resisting, or rejecting AA ideology and practices. While several small- scale components of AA ideology and practices were able to be modified or resisted by current members (e.g., constructing a personalised conception of a “higher power”), identifying as being powerless over alcohol was found to be a non-negotiable element of AA membership (Chapter 4). Findings also suggested that membership typically involves internalising the overarching narrative that “alcoholics” are emotionally and mentally sick (above and beyond problems with alcohol) and need AA to achieve and maintain wellness (Chapter 5). Ex-members reported ultimately rejecting various aspects of AA ideology and practices, such as the notions that they were powerless over alcohol, chronically sick, and needed to perform AA-recommended actions to maintain their recovery (Chapter 3). They commonly described AA’s understandings of “alcoholism” and approach to recovery as overpathologising, moralising, and detrimental to their sense of self and intellectual freedom. In contrast, most current members reported wholly positive experiences from accepting AA ideology and practices and valued their AA membership for supporting their abstinence, increasing their self-insight, and providing a routine of daily actions that enhanced their sense of wellbeing (Chapter 5). Findings additionally highlighted that the collective acceptance of AA ideology and practices within its peer-to-peer system can promote a level of conformity that can be constraining for individual members. Although identifying as having a shared disease of “alcoholism” generally provided a strong sense of belonging for members (Chapter 4), those who had left AA problematised the social forces that promoted the adoption of shared self-understandings and worldviews (Chapter 3). Ex-members discussed their integration into AA as a problematic “indoctrination” or “brainwashing” process and commonly sought assistance to “deprogram” from the beliefs they had adopted (Chapter 3). The analysis of current members’ responses similarly indicated that the internalisation of AA’s narrative within its peer-to-peer system can hinder members’ abilities to develop their own independence and individuality (Chapter 5). Overall, findings emphasised that the general acceptance of AA’s strong core narrative within the AA community can make it difficult for members to comfortably resist or reject aspects of AA, or to explore or embrace beliefs or behaviours that challenge AA. Conclusion This thesis enhances our understanding of how AA membership can be negotiated and the complexities and nuances inherent across individual experiences in AA. In particular, it illuminates key strengths and weaknesses of AA’s peer-to-peer structure and its strong core narrative that is internalised and embodied by members. It introduces a number of conceptual, practical, and ethical issues to consider, and highlights the importance of researching AA through theoretical frameworks that can produce balanced and critical analyses. Further research is required to more fully comprehend experiences in AA across larger and varied samples.
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