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The Anexo in Northern California: An Alcoholics Anonymous-Based Recovery Residence in Latino Communities



Our ethnographic study on help-seeking pathways of Latino immigrants in northern California reveals that they turn to anexos in their treatment and recovery quest. Anexos are linguistically- and culturally-specific recovery houses with origins in Mexico and Alcoholics Anonymous and a long history in Latino communities across the United States. Drawing on the findings of our study, we characterize the anexos and compare them to other recovery residences using National Alliance for Recovery Residences (NARR) criteria. The description and comparison reveal that anexos cannot be placed into a single NARR residence category. We discuss why this is the case.
The Anexo in Northern California: An Alcoholics Anonymous-
Based Recovery Residence in Latino Communities
Victor Garciaa, Anna Paganob, Carlos Recarteb, and Juliet P. LeeID,b
aDepartment of Anthropology and Mid-Atlantic Research and Training Institute for Community and
Behavioral Health (MARTI-CBH), Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
bPrevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
Our ethnographic study on help-seeking pathways of Latino immigrants in northern California
reveals that they turn to
in their treatment and recovery quest.
are linguistically-
and culturally-specific recovery houses with origins in Mexico and Alcoholics Anonymous and a
long history in Latino communities across the United States. Drawing on the findings of our study,
we characterize the
and compare them to other recovery residences using National Alliance
for Recovery Residences (NARR) criteria. The description and comparison reveal that
cannot be placed into a single NARR residence category. We discuss why this is the case.
Alcoholics Anonymous; anexos; Latinos; recovery houses; substance use disorders
Public health research has documented the importance of a safe, stable, and sober living
environment for individuals recovering from substance use disorders (SUDs; Jason &
Ferrari, 2010; Polcin, 2001). Without it, recovery is more difficult to sustain, regardless of
personal motivation and readiness for recovery. Based on research demonstrating favorable
outcomes, researchers, service providers, and policymakers have advocated for the use of
recovery residences (Polcin, 2009a; Wittman & Polcin, 2014). Multiple types of recovery
residences have been identified in the literature, such as Oxford Houses and California Sober
Living Houses (Jason, Olson, Mueller, Walt, & Aase, 2011; Polcin, 2009b; Wittman &
Polcin, 2014).
Although these well-known recovery residences have been studied for decades, there is a
need for more comparative research to understand more fully their contributions to recovery
for different populations. For instance, a recent study of dually diagnosed justice-involved
persons found that those who lived in recovery residences after completing inpatient
treatment reported significant reductions in psychiatric severity as compared to those
CONTACT Victor Garcia,, Department of Anthropology, G1 McElhaney Hall, Indiana University of Pennsylvania,
Indiana, PA 15705-0001.
Juliet P. Lee
HHS Public Access
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J Groups Addict Recover
. Author manuscript; available in PMC 2018 June 23.
Published in final edited form as:
J Groups Addict Recover
. 2017 ; 12(2-3): 158–176. doi:10.1080/1556035X.2017.1313147.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
referred to treatment as usual (Majer, Chapman, & Jason, 2016). There is also a need to
include in comparative research lesser-known recovery residences such as the
, a
linguistically and culturally specific recovery residence with a long history in the Latino
community (Pagano, 2014).
Our objective is to characterize the anexo, an understudied recovery residence with origins
in Mexico and Alcoholics Anonymous (AA). These recovery residences are mainly found in
urban areas throughout United States with large concentrations of Mexican and other Latino
immigrants. The actual numbers of anexos are unknown given that, unlike in Mexico, they
are not part of a larger anexo association, nor are they registered with the government. In
particular, we address how the anexo compares to other recovery residences in the United
States. We apply the same criteria to the anexo that other researchers have used to identify
and categorize recovery houses according to four levels: Level I, Peer-Run; Level II,
Monitored; Level III, Supervised; and Level IV, Service Provider (Mericle, Miles, Cacciola,
& Howell, 2014). The criteria, established by the National Association for Recovery
Residences (NARR), comprise: (a) residence, (b) staffing, (c) administration, and (d)
services (NARR, 2011, 2012). In using these criteria, we do not seek to classify anexos into
one of the four levels of recovery residences. Instead, we use the NARR criteria as a
heuristic tool with which to examine the similarities and differences between Northern
California anexos and other types of recovery residences. These criteria will help us to
determine to what extent the anexo represents a unique type of recovery residence.
The anexo
Anexos are recovery residences operating in the United States, Mexico, Guatemala, El
Salvador, and other countries, including Spain (Coatecatl, 2012). In the United States, they
are independent AA recovery houses, and most are not registered with the International 24-
Hour Movement, an anexo association in Mexico City that provides guidelines for these
recovery residences (Movimiento Internacional 24 Horas Alcohólicos Anónimos, 2016). In
Northern California, where we conducted our research, anexos were established by Mexican
and Central American immigrants in Latino communities. They mainly provide their
services to men, although in the past women were also welcomed; however, because of
problems that arose in housing men and women together, this practice did not continue.
Anexos offer an affordable, structured, and culturally appropriate recovery support
environment that incorporates AA principles and practices. The recovery program is offered
in the Spanish language and draws on the cultures and immigrant experiences of the
residents, serving immigrants and, to a lesser extent, second generation Latinos, or Latinos
born in the United States to immigrant parents. These populations, particularly individuals
experiencing stress associated with acculturation to U.S. cultural norms, are more likely to
suffer from mental health problems and substance use disorders, according to a recent study
(Lopez-Tamayo et al., 2016). The recovery residences are called anexos because in Mexico,
they are annexed to, or associated with, a traditional AA group. They are also known as 24-
hour AA Groups. In the United States, this is not the case; anexos operate independently of
traditional AA groups.
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Latinos, anexos, and other U.S. recovery residences
Despite their presence in the United States for at least 25 years, anexos have not received
research attention. To our knowledge, our study is the first long-term ethnographic research
on U.S. anexos. In Mexico, where the anexo originated over 40 years ago, there are only a
limited number of studies, most of which have been conducted in the Mexico City
metropolitan area. As we have addressed elsewhere, despite sharing some characteristics—
especially in their adherence to AA principles and mandatory AA meetings—anexos in the
two countries are not identical (Pagano et al., 2016). It is important to note that anexo
participation in our research site is voluntary and corporal punishment is not used, in
contrast to some anexos in Mexico that are not registered with the International 24-Hour
Movement nor the government. These nonregistered anexos in Mexico operate clandestinely
and do not undergo any kind of oversight (Marín-Navarrete, Eliosa-Hernández, Lozano-
Verduzco, Turnbull, & Tena-Suck, 2013).
There is limited research in Mexico concerning the anexo’s origins, in particular the history
of the 24-Hour Movement and the rise of anexos (Rosovsky, 1998, 2009). The extant
literature also identifies significant variation among anexos in Mexico according to whether
or not they are registered with the Movimiento Internacional 24 Horas Alcohólicos
Anónimos or the government, the organization of each anexo, and their policies in regard to
being “open” or “closed” to the public (Lozano-Verduzco, Marín-Navarrete, Romero-
Mendoza, & Tena-Suck, 2016; Marín-Navarrete et al., 2013; Pulido, Meyers, & Martínez,
2009). More recently, research in Mexico City has examined the unorthodox practices of
some anexos that have cast a dark shadow over these recovery centers (García & Anderson,
2016). Some of the reported practices include physical restraint, verbal abuse, prolonged
kneeling, and hitting and kicking (García & Anderson, 2016). It is important to note that the
anexos in our research site abhor such punitive practices.
Anexos were founded on the premise that individuals with severe SUDs need a facility
where they can undergo detoxification and remain for extended periods until they are ready
to live independently without the use of alcohol or other drugs (Rosovsky, 2009). During
their stay, residents learn about AA, the emotional roots of their SUDs, and the need to
maintain their sobriety for their well-being and the welfare of their families.
In the United States, there is little research on Latinos’ use of other recovery residences.
This may be due in part to the fact that Latinos underutilize SUD treatment services in
general as compared to other racial/ethnic groups, despite comparable prevalence of SUDs
among this population (Alvarez, Jason, Olson, Ferrari, & Davis, 2007; Castro & Tafoya-
Barraza, 1997). There may also be other recovery residences in Latino communities, like the
anexo, that have not been identified. One study of 170 Oxford Houses across the country
found that Latinos represented only three percent of residents (Jason, Davis, & Ferrari,
2007). The authors attribute the low numbers to a lack of information within the Latino
community regarding the existence of Oxford Houses and other recovery houses (Alvarez,
Jason, Davis, Olson, & Ferrari, 2009). Because many do not undergo formal SUD treatment,
they may not receive referrals to this recovery resource. Another explanation given is that
many recovery houses do not offer their services in the Spanish language or incorporate
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aspects of Latino culture, making them less attractive to some Latinos with SUDs (Alvarez,
Jason, Davis, Ferrari, & Olson, 2004; Contreras et al., 2012).
Despite their low numbers, two studies found that Oxford Houses contributed to the
recovery of Latino residents (Alvarez et al., 2009; Contreras et al., 2012). Among the
benefits identified were peer support, a sober living environment, and an emphasis on
personal accountability. Intervention studies on bilingual/bicultural Oxford Houses, created
by researchers to assess their effectiveness for Latinos, found that using the Spanish
language and emphasizing cultural values such as personalismo (i.e., close and personal
relationships), simpatía (i.e., harmonious interpersonal relationships), and familismo (i.e.,
emphasis on family) made the modified recovery residence more culturally appropriate for
Latinomale residents (Contreras et al., 2012; Jason et al., 2013).
Setting and objectives
Our 2-year ethnographic study of three anexos was conducted in a mid-size city in Northern
California. The main objectives of the study were to identify the help-seeking pathways of
Latino males who accessed the anexos in our study; to examine the anexos’ recovery-
promoting practices; and to assess residents’ perceptions of the benefits and drawbacks of
anexo programs. We also gathered information on how the anexos are structured and
organized and observed their operations on a daily basis over the course of the study. Their
histories, characteristics, and recovery promoting practices were compared with one another.
Recruitment and sampling
We began to establish relationships with the anexos in our research site in 2011. Our entrée
was facilitated by an anexo resident who volunteered with one of the authors at a nearby
community health clinic. That author conducted ethnographic observations and exploratory
interviews with current and former anexo directors as part of another project (Pagano, 2014).
Three of the four anexos contacted elected to participate in the two-year study described
In 2014, we visited each of the anexos and gave a brief presentation on the study at their
nightly AA meetings. During these presentations, we introduced ourselves and invited
interested residents to speak with us if they wished to be interviewed. In all, we recruited 42
residents, three directors, two former directors, and three assistant directors or
= 50) for interviews (see Table 1). Resident numbers in each anexo fluctuated over the
course of the research. In general, the first anexo had between 12 and 20 residents, the
second had 12 to 24, and the third had between 30 and 50.
We also attended other open AA meetings and events at the anexos and actively recruited
interviewees during these visits. Our recruitment strategy combined convenience sampling
with purposive sampling, as we attempted to balance proportions of interviewees by
nationality (Mexico, United States, or Central American countries), age (18–29, 30–45, 46–
60, over 60), and time in the program (0–3 months, 4–6 months, over 6 months) within each
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anexo (Bernard, 2006; Marshall, 1996). We oversampled Mexican residents because they
were the most prevalent national group in each anexo.
First, we conducted over 200 hours of participant observation (over 60 hours in each anexo)
between July 2014 and April 2015. Observed events included anexo AA meetings, residents’
and directors’ sobriety anniversary celebrations, anexo anniversary celebrations, and “down
time” during the day. We continually informed anexo residents, especially new residents,
about our study. Participant observation sessions ranged from 1 to 6 hours at a time. After
each session, we wrote up qualitative field notes detailing our observations. During our
observation visits, we sought permission from the individuals present in common areas to
stay and observe their activities. We did not enter the dormitories, and the men who were not
interested in being observed retired to their sleeping quarters.
Second, we conducted 50 semistructured interviews (42 residents, three directors, two
former directors, and three assistant directors). Our interview guide featured questions about
demographics, work and migration history, use and abuse of alcohol and illicit drugs, help-
seeking trajectory, experiences in the anexos, anexos’ structures and routines, perceptions of
the anexos’ efficacy, and general access to recovery services. Interviews lasted between 1.5
and 2 hours each and were digitally recorded. About three-fourths of the interviews took
place in a private room in the anexo, whereas the others took place at nearby restaurants or
cafes. All but five were conducted in Spanish; these five were conducted in English or in
both Spanish and English. All interviews were transcribed in their original language for data
analysis purposes. Each anexo received $400 in grocery gift cards for participating in the
study. At the start of each interview, verbal informed consent was obtained and digitally
recorded. Our informed consent procedures and all other human subject protection measures
were approved by the Institutional Review Board of the Pacific Institute for Research and
Data analysis
Thematic analysis of qualitative data was guided by grounded theory (Charmaz, 2006;
Glaser & Strauss, 1967). After 9 months of field work, we met on several occasions to
construct a code book. The code book included a priori themes that were drawn from our
study questions and ad hoc themes that emerged from repeated readings of field notes and
interview responses (MacQueen, McLellan, Kay, & Milstein, 1998). Interview transcriptions
and field notes were then uploaded into the ATLAS.ti software program for coding (Muhr,
2013). We continued to meet during the coding process to ensure agreement on the
meanings of codes and their application to specific text passages. Emergent codes were also
discussed at these weekly meetings as they were added to the code book.
For the comparison between the anexo and the NARR housing levels, we searched our coded
text for information on the different aspects of the anexos’ structure, organization, and
operation, and categorized germane text according to residence, staffing, administration, and
services. The latter four items are key criteria used by the NARR to identify and categorize
the recovery residences according to four levels: Level I, Peer-Run; Level II, Monitored;
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Level III, Supervised; and Level IV, Service Provider. Themes and subthemes around the
four criteria were identified, and included but were not limited to residence types and the
characteristics and number of residents, staffing and staff responsibilities, administration
practices and policies and procedures, and the different services offered. Information on the
four recovery residence levels was obtained from the literature and NARR online resources
(see NARR, 2012). We compared the results of our thematic analysis with corresponding
NARR information, examining the similarities and differences according to the four criteria
across the three anexos and between the anexos and the four NARR levels of recovery
residences. The results of the comparison were used to prepare narratives for our findings.
Our findings are organized according to the sub-elements of NARR’s recovery residence
levels: residence, staffing, administration, and services. We describe each of the sub-
elements, as found in the anexos, and then determine how they correspond to the four NARR
levels of recovery residences.
The anexo in Northern California
Similar to many anexos in Mexico and the United States, the anexos in our study consider
themselves 24-hour AA groups, although they are not registered with the International 24-
Hour AA Movement in Mexico or the AA Central Office in Mexico. They display a
modified AA logo (with “grupo 24 horas” printed in the upper right-hand corner) on the
windows or doors of their buildings and their names reflect recovery maxims, such as
“Learn to Live Again” or “Give Yourself another Chance.” Anexos are open to anyone
seeking help with only one restriction, gender; the three anexos in our study only accept
The majority of residents in the three anexos are immigrants and former migrants from
Mexico and Central America. Severe SUDs have disrupted the labor practices of the once-
migrants, and consequently they no longer return to their countries of origin. Many have not
worked for some time and thus have been unable to provide for their families in the United
States or abroad. Some residents immigrated as children with their parents, and a few are
second-generation bicultural and bilingual Latinos. Many of the foreign-born residents lack
U.S. government authorization to live and work in the United States. Nonlocal residents
learn of the anexos from relatives or friends, often coming from the San Joaquin Valley or
occasionally from as far away as Nevada. The predominant language in the anexo is Spanish
from Mexico and Central American countries, although some residents speak indigenous
languages back home. The residents’ culture is a hybrid consisting of cultural elements from
their countries of origin (primarily Mexico, Guatemala, El Salvador, and for the second
generation, the United States). Spanish language use and a familiar culture were reported as
major reasons that the men seek out and remain in anexos. Another reason is the residents’
ability to share common experiences as immigrant Latinos and support one another through
challenges. Their life in the homeland, border crossings, and immigrant experiences are
often themes and subthemes in their AA testimonials.
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The anexo: Residence, staffing, administration, and services
Residence (physical structure)—The three anexos operate independently but
collaborate and support each other by attending each other’s AA meetings, group
anniversaries, and other AA fellowship events. They also make referrals to each other’s
anexos if their residence is at capacity. All three are well-established in our research site; at
the time of our study, one had been in operation for 7 years, another for 13 years, and the
oldest for 17 years. All three are housed in old commercial buildings built decades ago. The
buildings have large open floor areas that perhaps once served as stores or storage areas but
are now used by the anexos to hold AA group meetings. They also have additional rooms
that may have been offices or storage rooms in the past but are now used as sleeping
quarters. The floor plans differ among anexos, as do the living arrangements. In one anexo,
the meeting room and sleeping quarters are in the same area and building, while in the other
two anexos, the sleeping quarters are in different but adjacent building complexes. All three
meeting rooms open onto major streets in predominantly Latino urban neighborhoods.
For the sake of brevity, we will only describe in detail the largest of the three anexos. During
our study, this anexo served approximately 45 residents at a time on average. Its main
location, where AA meetings are held and most residents live, is a rented commercial space
on a major boulevard. It occupies the second floor of this commercial space, which is
organized into a common area used for AA meetings, two dormitories, a split bathroom, and
a kitchen and dining area. Because of the anexo’s rapid growth, which was fueled by the
demand for treatment, its director also leased a single-family home in a nearby residential
area. The second location houses residents who have been at the anexo for at least a year (in
most cases) and can afford to pay the higher rent. Residents at this second location return to
the main location for nightly AA meetings and special events. At both locations, residents
share meals and chores and are generally responsible for the upkeep of the anexo. Both
anexo locations are in the city’s predominantly Latino neighborhood, and near public
The residences are not owned by the anexo directors or residents. Rather, directors rent
anexo spaces with residents’ dues and collections at the anexo AA meetings. When there is
shortfall in funds, the directors cover the difference themselves. Following AA Tradition
Seven (“Every AA group ought to be fully self-supporting, declining outside contributions”),
the anexos are self-sustaining and do not seek or receive government assistance. Each
resident contributes $60–80 each week for room and board, but men are not evicted if they
cannot find enough work to cover their stay. In some cases, residents who receive
Supplementary Security Income disability or general public assistance sign their checks over
to the anexo to cover room and board. However, men who are unemployed or
underemployed receive free room and board until they are able to find work again. In the
weeks before special events, such as individual sobriety anniversaries or anexo group
anniversaries, additional donations are solicited from the residents and others who attend
AA meetings at the anexo.
Staffing—True to the AA principle of service, anexo staff are former and current anexo
residents who volunteer their time. The anexos have no paid staff or clinicians, as directed in
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AA Tradition Eight (“Alcoholics Anonymous should remain forever nonprofessional…”).
The top leadership position is that of the director, also referred to as
“godfather”), who resides off-site but is present at nightly AA meetings and house meetings.
The term padrino is also used to refer to an AA sponsor, but when used in reference to a
director it signifies his leadership, mentorship, and patronage of the group. The director is
usually the founder of the anexo and is either self-appointed or invited to occupy the position
when a previous director leaves his post.
The second staffing level consists of one or more encargados, or assistant directors who
reside on-site and may receive free room and board. They are usually long-term anexo
residents with a year or more of stable recovery, but there are exceptions to this rule.
translates roughly as “one who is entrusted with a responsibility.” In the case of
the anexo, encargados are responsible for the daily operations of the residence. They ensure
that schedules are followed, meetings are attended, and house rules are enforced.
Encargados are selected at the director’s discretion following consultation with the
, or board, which consists of the anexo director, an encargado, a secretary, a group
anniversary organizer, and an AA literature coordinator. Not all board members reside at the
anexo; some are external members who attend AA meetings at the anexo. The board
primarily manages the anexo’s finances, helps to plan and organize events, such as
anniversaries, and helps resolve problems that may arise.
Administration—The anexo is administered according to unwritten house rules under the
direction of the director and his selected team. In accordance with AA Tradition 2, which in
part reads “Our leaders are but trusted servants; they are not to govern,” the directors and
encargados are facilitators rather than authoritarian figures. The residents are given the
opportunity to question and make suggestions regarding the daily operations of the
residence. Although directors have the final word on how their anexo is administered, they
usually inform the residents of decisions and their rationales during evening AA meetings.
These meetings serve as house meetings in which the men are given the opportunity to ask
questions and share opinions. Decision making regarding daily operations and special events
is accomplished largely through group consensus, although not all decisions are discussed or
approved by the group. Examples of executive decisions made by the director include
determining appropriate disciplinary action for breaking anexo rules, selecting new
encargados, and choosing which residents will represent the anexo at state and regional AA
The three anexos in our study offer similar services. They consist of detoxification,
structured living arrangement, service to others, AA group meetings, and aftercare.
Detoxification—Anexos make no distinction between recovery from alcohol versus other
drugs; they simply follow the AA program and use AA literature. Our study participants
reported long histories of heavy drug use, including alcohol, crystal methamphetamine,
marijuana, crank, powder cocaine, crack, heroin and other opiates, ecstasy, PCP, and
hallucinogenic mushrooms. Most participants were poly-drug users, often using more than
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one drug over the course of their lifetime or in a single episode. Given this heavy drug use,
the anexo program often begins with detoxification. If withdrawal symptoms can be
managed in-house by experienced residents, the detox takes place at the anexo (i.e.,
nonmedical or “social” detoxification); if they require medical attention, new arrivals are
taken to a local hospital emergency department (Lapham, Hall, Snyder, & Skipper,
1996;Whitfield et al., 1978). Regardless of where it starts, anexo residents complete their
detoxification phase in a room isolated from the other residents for three to seven days. This
room is referred to as
, or mattresses. Newly arrived men who have already
undergone detoxification do not go through the colchones phase. This is rare, since most
residents are still using drugs when they reach the anexo.
Structured living arrangement—From the colchones, the men join the other residents
and are assigned a bed in rooms converted into barrack-style dormitories. During the first
few weeks of the program, the new arrivals are not to leave the premises without permission
from the director or the encargado. To do so is grounds for dismissal. Restricting the men’s
time away from the anexo limits their contact with drug-using acquaintances and
environments where alcohol and other drugs are available. From the start, the men are
encouraged to eat well, rest, and see a doctor if they have a medical problem. Free health
clinics are suggested for residents who lack medical insurance. Those with criminal justice
involvement are advised to seek free or low-cost legal services from Latino-serving
community organizations in the area. If they need to attend a doctor’s appointment or a court
hearing, they are accompanied by a resident or encargado to make sure they do not drink or
use drugs while away from the anexo.
Residents with more time in the anexo may serve informally as padrinos, or sponsors, to
newcomers, but it should be noted that having a padrino in the anexo is not a requirement.
Padrino and “sponsor,” albeit similar on the surface, are not identical in Latin American and
Latino culture. In these cultures, a padrino is often associated with Catholic rites, such as
baptism, confirmation, and weddings, and as such he is a mentor, patron of important events,
and a protector. Anexo residents who serve as padrinos offer the new arrivals an orientation
to the anexo, advice and help in “working” the recovery program. As in traditional AA
groups, a sponsor is someone who has been abstinent for a long period and is prepared to
guide a newly abstinent resident in his recovery. Padrinos can be fellow residents with more
than one year of sobriety, former anexo residents, or members of traditional AA groups.
Residents follow a structured daily schedule with specific times for sleeping, waking, eating
meals, performing daily chores, and attending mandatory on-site AA meetings. The
structured living arrangement also includes employment. After several weeks, new residents
are encouraged and permitted to work outside of the anexo. Typically, they will obtain work
either through leads from established residents or at a nearby day labor hiring zone, referred
to as
la esquina
(the corner). The employment they obtain tends to be manual, unskilled
labor that pays 8 to 10 dollars per hour, although some residents who perform shift work in
local businesses, such as car washes, mechanic shops, or restaurants, earn slightly more.
Unemployed residents help cook, clean, and maintain the anexos.
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The residents are to follow house rules. Each of the three anexos have similar rules which
include but are not limited to the following:
no alcohol or drug use on or off the premises;
no fighting or violent/threatening behaviors;
directors or their assistants must be informed of the residents’ whereabouts at all
assigned chores must be completed; and
attendance at nightly (and sometimes daily) AA meetings is mandatory.
Breaking the rules results in disciplinary action. Residents who initiate or participate in
verbal or physical violence are asked to leave the anexo. Other infractions (e.g., returning
late from an approved family visit, missing an AA meeting without prior approval) result in
additional everyday chores, such as cleaning the restrooms, or being restricted to the facility
for a short time.
Residents who relapse may be asked to leave the program, but if permitted to stay they are
required to return to the colchones and start the program again. Whether they stay or leave
depends on the severity of the relapse, how many times it has occurred, the level of remorse
shown, and the resident’s reputation in the anexo before the relapse event.
Service to others—Service is an integral part of the anexo program, as it is with
traditional AA groups. According to director interviews, service promotes responsibility in
the residents and occupies them so that they do not dwell on thoughts that are
counterproductive to recovery. Residents can provide service in several ways, such as
fulfilling specific roles at evening AA meetings. These roles include meeting coordinator,
who is in charge of keeping a log of activities, calling on the men to share a testimonial, and
keeping order; reader of the 12 steps and traditions and other passages of the AA literature;
food and beverage server, also known as
(coffee maker) who provides coffee upon
request; and donation collector. Residents take turns serving in these positions. Service in
the anexo can also involve sitting on the anexo’s board (mesa directiva) or ad hoc
committees created by the board to assist with special events, such as organizing individual
sobriety and group services and planning meetings with other anexos and traditional AA
groups. For more experienced residents, service may include volunteering at local
community organizations, speaking at other AA groups’ events, or even visiting community
clinics or churches to speak about AA and recovery.
AA group meetings—The structured life of the anexo includes mandatory, nightly, 2-
hour-long AA meetings. One anexo in our study had an additional mid-morning meeting for
residents who did not work during the day. These meetings are open to the public and
incorporate cultural elements and rituals characteristic of AA culture in Mexico and Central
America, such as the use of the Spanish language; cross-talk; jokes about masculinity rife
with sexual innuendo; frequent references to God, saints, and the presence of Catholic
iconography in meeting spaces; and making the sign of the cross after the sobriety prayer.
Some of these practices have been noted in other studies of Latino AA groups (Davis, 1994;
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Hoffman, 1994; Room, 1998). Members of Spanish-language AA groups attend the anexo
AA meetings to show their support and solidarity, and anexo members attend outside AA
meetings, especially for abstinence anniversaries. Testimonials at anexo AA meetings center
on alcohol and drug abuse, related transgressions, and group members’ trials and tribulations
with their recovery efforts in their homelands and in the United States. Mexican and Central
American colloquialisms and regional idioms are used to make a connection with fellow
countrymen. Cross-talk, or exchanges between the speaker at the podium and audience
members, is common. It is used to identify with the speaker’s experience, to question the
speaker’s sincerity, or to make jokes about something the speaker is saying or about the
behavior of another resident or AA group member. Although cross-talk is discouraged in
English-language AA, it is socially normative at many Spanish-language/Latino AA
meetings in the United States (Hoffman, 1994).
Every month, a particular step (one for each of the 12 months) is emphasized in the group
meetings, but other steps can be discussed if requested by meeting attendees. Although
encouraged by directors, studying the 12 steps individually is not the main priority. The
focus, rather, is on putting them into practice and discussing difficulties and successes in
doing so at the group meetings. The first step, in particular (“We admitted we were
powerless over alcohol - that our lives had become unmanageable”), is constantly reinforced
in anexo AA meetings to remind residents of the severity of their addictions.
Aftercare—Although a 12-month stay is recommended, the men are free to leave the anexo
at any time during the program. Readiness to leave is determined by the resident in
consultation with his padrino, if he should have one, the director, and encargado. Although
no formal assessment is used in the anexos, the resident’s recovery progress is monitored.
Directors shared that they assess progress using two main factors: how long the individual
has maintained his sobriety, and the personal growth he has demonstrated during
interpersonal interactions and testimonials. Evidence of personal growth, according to
directors, includes exhibiting unselfish behaviors and thinking, taking responsibility for
one’s actions, and showing evidence of working the AA traditions and steps into one’s daily
The anexo has no formal aftercare. It is up to former residents to stay committed to their
sobriety and recovery. They are encouraged to continue attending nightly AA meetings at
the anexo or elsewhere, and to stay in touch with their padrino. The meetings are important
because, as residents and directors explained, the meetings help the individual to purge
whatever is bothering him and to be in close fellowship with others who have similar
struggles. Men who live nearby after their stay often continue to attend AA meetings at the
anexos, and may attend Spanish-language AA groups in or near their neighborhoods. The
men are also encouraged to continue their service at the anexo, either as a member of the
mesa directiva or by serving as a padrino to the residents, and to the community-at-large by
spreading the word of the anexo and AA.
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The anexo and NARR recovery residence types
NARR identifies four recovery residence types—Level I, Peer-Run; Level II, Monitored;
Level III, Supervised; and Level IV, Service Provider—using residence, staff,
administration, and services as criteria (NARR, 2012). Level I are single family structures
with no paid staff and are administrated democratically according to a standard manual or
set of policies and procedures. Services include drug screening, house meetings, and non-
mandatory self-help meetings. Examples of Level I recovery residences are Oxford Houses
(NARR, 2012).
Level II are single family residences but may include other dwelling types. There is at least
one paid staff member and a house manager or senior resident and a set of policies and
procedures. Services consist of structured living around house rules, peer-run groups, drug
screening, house meetings, and involvement in self-help and/or in house clinical treatment
services. Sober living houses, similar to those in southern California, are examples of Level
II recovery residences (NARR, 2012).
Level III vary in residential settings but have a facility manager and certified staff or case
managers, an organizational hierarchy, oversight for service providers, policies and
procedures, and licensing. Services include an emphasis on life skill development, clinical
services in the community, and in-house service hours. Examples of Level III recovery
residences are “social model” recovery programs, “which emphasize experiential learning,
peer support, and 12-step recovery principles within a semi-structured group living
environment” (NARR, 2012).
Level IV also vary in residential settings but with a more institutional environment,
including paid and credentialed staff, clinical and administrative supervision, policies and
procedures, and licensing. Services are clinical and ancillary programming and focuses on
housing and life skill development. Examples of Level IV recovery residences include
residential therapeutic communities for drug treatment (NARR, 2012).
In regard to physical residence structures, the anexos in our study include aspects of NARR
Levels II and III. One anexo in our research site (not enrolled in our study) is more in line
with Level I, as it is housed in a single-family dwelling. One of the three anexos in our study
is housed in an old commercial building with a converted second-floor space for AA
meetings and sleeping quarters. The other two anexos are housed in multiple adjacent
buildings, including one where AA meetings are held and colchones residents stay, and one
or more other buildings with apartments for established residents.
As for staffing, anexos are more in line with NARR Levels I and II. The staff is limited to
directors and assistant directors who make decisions independently of the residents and are
responsible for the daily operations of the anexo. They do not undergo any formal
preparation; that is, they are not licensed, as clinicians and therapists are. The directors are
either founders of the anexo or former assistant directors who took over after one of the
directors stepped down. Assistant directors are selected on the basis of their longevity at the
anexo, trustworthiness, and stage of recovery. Two of the three anexos in our study had
staffing arrangements similar to those in Level I; that is, there were no paid staff. The other
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anexo was similar to Level II in that its encargado (assistant director) was not paid, but
received free room and board. This arrangement is closer to NARR Level II residences but is
not common among anexos in our research site.
The administration of the anexos resembles some features associated with NARR Levels II
and III. The leadership in the three anexos consists of the directors and the encargados who
work closely with a board made up of appointed members. Together, the director,
encargados, and board form an organizational hierarchy and run the anexos according to an
internal, unwritten policy and set of procedures. Despite this top-down administrative model,
the residents have opportunities to make suggestions and voice opinions at group meetings.
The services at the anexos are similar to those in NARR Level I and II recovery houses, and
have some features of Level III. Similar to Level I, the anexos hold house meetings, and one
of the three anexos occasionally conducts urine and breath testing of residents suspected of a
relapse. Similar to Level II, the anexos provide structured living around house rules and
require mandatory participation in evening AA meetings. Also, as in Level III houses, the
anexos emphasize life skill development by encouraging the residents to seek and hold
employment, manage resources, and to work on familial and other personal relationships.
As described above, the anexo does not fall within a single NARR typology. The three
anexos in our study have characteristics and practices found in three of the four levels of
recovery residences: peer-run (Level I), monitored (Level II), and supervised (Level III). In
regard to physical residence structure, the anexos are similar to Level II and III. The anexos
are housed in different types of buildings, and as such do not conform to a single recovery
residence type. Buildings are selected according to their location and availability,
appropriate space, and affordability. The structures are located in Latino neighborhoods or
nearby communities and are selected to accommodate group meetings and to house anexo
residents. This space can be a single structure, as is one of the three anexos in our study, or it
can be a building with a meeting hall and adjacent apartments, as is the case in the other two
anexos. Rent and utilities must be affordable, given that these primary expenditures are paid
in the collective by the residents, some of whom are not always gainfully employed. All
three anexos are known to the local authorities, including the judicial system that accepts
anexo stays as fulfillment of mandated SUD treatment. Anexos operate openly as informal,
community-based recovery houses where individuals with SUDs help one another through
the process of recovery.
The staffing of the anexos is similar but not identical to NARR level I. The staff are not paid,
which is similar to Level I, but the anexos are not administered democratically according to
written policies and procedures, as may be the case with Level I. In line with AA traditions,
the anexos adhere to a self-help philosophy in which the men depend on each other for their
sobriety and sustained recovery. This self-help takes the form of communal service, which
excludes hiring therapists or other clinicians at the anexo and compensating staff. AA
traditions also state that groups must be as self-sufficient as possible, which means not only
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that they should not receive funding from outside sources, but also that they limit their
recovery practices to the AA steps and traditions.
The anexos in our study feature administrative practices more in line with NARR Levels II
and III. Despite their adherence to AA philosophy, anexos are not self-governed; that is,
residents do not have much of a say in how the anexo should be operated, as is the case in
Level I recovery residences. Anexos also are not administered, monitored or supervised by
outside bodies, such as governmental agencies or licensed service providers, including
clinicians. The anexos are administered by the director, a former resident who follows an
unwritten but consistent set of policies and procedures, assistant directors, and board
members. They run and supervise the activities at the anexo in a hierarchical fashion. Rules,
directives, and reprimands are from the top down. These administrative practices are similar
to those of anexos registered with the International 24-Hour Movement in Mexico.
The services in the anexo are similar to those in NARR Level I, II and III. Anexos offer a
continuum of services from detoxification to aftercare under the same roof, except for
detoxification requiring medical care. As with the administrative practices, these services are
similar to those provided by anexos in Mexico (i.e., AA meetings, informal sponsorship, and
aftercare). Together, the services address many areas of recovery in a single comprehensive
A major reason that the anexos are similar to more than one NARR level is that the anexos
are not part of any recovery residence association in the United States or the 24-Hour AA
Movement in Mexico, and as such are not subject to any of their regulations. It also is not
based on residence recovery models found in the United States, but is rooted in a different
cultural tradition—the 24-Hour AA Movement in Mexico—and reflects features associated
with that tradition. Three decades ago, traditional AA groups in Mexico City opened anexos
so that individuals who could not afford residential treatment could have a place to sober up
and work on their recovery. The anexo was a grassroots response to an immediate and
growing need. Today, as in the past, anexos in Mexico arise where space is available and do
not operate according to a standardized set of procedures, other than putting into practice the
AA program in a residential setting. The vast majority of group members are low-income
with chronic substance use disorders. Private treatment is beyond their means, and
government-run clinics are scarce, if available at all, in much of Mexico.
The anexo in Northern California is also a grassroots response to a community need. Latino
immigrants and migrants turn to the anexos for assistance with their substance use disorders,
as do second-generation Latinos. Unlike immigrants and migrants, who are not always
eligible for government-sponsored recovery programs because of their immigration status,
second-generation Latinos have other options. Yet, as we have discovered, some prefer the
anexo over other programs. Immigrants, migrants, and the second generation share a
common language, a similar culture, and often undergo similar experiences of exclusion in
the United States, regardless of their citizenship status. These cultural similarities bring them
together for a common cause—their recovery and the recovery of others.
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Although anexos in our study approximate the anexo model of Mexico, they have made
significant modifications due to different cultural and political realities in the United States,
as discussed elsewhere (Pagano, Garcia, Recarte, & Lee, 2016). Unlike their Mexican
counterparts, Northern California anexos are not established or maintained by a traditional
AA group in the community. They are independent, and each one operates according to its
own policies and procedures. The anexo is not known outside of the Latino community, and
there are challenges to opening anexos that are not necessarily faced in Mexico or other
countries. In these countries, discrimination, anti-immigrant sentiments, zoning laws, safety
regulations, and not-in-my-backyard reactions are less of a barrier than they are in the
United States. The anexos in our research site have adapted to the U.S. cultural and political
contexts and have come to resemble sober living houses in some ways (Pagano et al., 2016).
Our exploratory study on the help-seeking pathways of Latino immigrants generated data
that allowed us to characterize the anexo, who it serves, and how it works. Our study did not
include measures on its effectiveness or comparisons of its outcomes to those of other
recovery residences. Our next study on the anexos will address its effectiveness in recovery.
In addition, despite our long-term ethnographic fieldwork, it is important to acknowledge
that our findings pertain to the anexos in our research site of Northern California, and may
not be generalizable to anexos in other parts of the United States. Although there is a well-
established literature on recovery houses, up until now it has not included the anexo. More
research on this understudied recovery house should be a priority.
Anexos provide much-needed recovery services in Latino communities and serve some of
the most marginalized and vulnerable populations suffering from SUDs. Their services are
affordable; do not require medical insurance; are linguistically and culturally appropriate;
and are not based on immigration or citizenship status. Thus, for many undocumented
residents in the United States, the anexo is their only option for recovery services. Recovery
residences are often described as part of the “continuum of care,” that is, as a complement to
ongoing treatment interventions or as aftercare for individuals who have graduated from a
residential treatment program. By contrast, anexos are the entire continuum of care for many
immigrants and other Latinos with SUDs. They admit residents, help them through
detoxification, provide a structured program with incremental increases in independence,
help residents to rebuild their lives by connecting them with employment, medical, and
social services, and provide informal aftercare for those who complete the program. They
are a self-sustaining, grassroots recovery house model that represents a community-based
response to a critical gap in SUD services for a present and expanding U.S. workforce.
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Table 1
Sample characteristics (
= 50).
Features n (%)
Age (in years)
) 40.5 (12.6)
Median 38
Range 20–75
18–24 4 (8)
25–34 15 (30)
35–44 13 (26)
45–60 16 (32)
over 60 2 (4)
Country of origin
Mexico 34 (68)
United States 6 (12)
Guatemala 4 (8)
El Salvador 4 (8)
Honduras 2 (4)
Education (years of school)
None 2 (4)
Elementary (1–6 years) 11 (22)
Middle (7–9 years) 8 (16)
High (10–12 years) 18 (36)
College (12+ years) 11 (22)
Marital Status
Single 29 (58)
Married 4 (8)
Separated/divorced 16 (32)
Widower 1 (2)
Immigration status
Undocumented 29 (58)
Permanent resident or TPS 14 (28)
U.S. citizen 7 (14)
. TPS = temporary protected status.
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... There is evidence that Latino immigrants create grassroots recovery systems for substance use disorders (SUDs) in their communities. Examples include Spanish-language Alcoholics Anonymous groups (Hoffman, 1994), grupos de cuatro y quinto paso, or fourth and fifth step groups (Garcia, Anderson, and Humphreys, 2015), and 24-hour Alcoholic Anonymous groups, also known as anexos (Garcia, Pagano, Recarte, & Lee, 2017). Here, we focus on the anexo. ...
... Rooted in the "24-Hour" AA Movement which originated in Mexico, anexos have operated in the United States for nearly 25 years (Garcia et al., 2017;Pagano et al., 2016). The anexos in U.S. Latino communities are independent and consider themselves AA groups, but are not recognized by Alcoholics Anonymous World Services, Inc. or La Central Mexicana de Servicios Generales de Alcohólicos Anónimos, Mexico's equivalent of the U.S. General Service Office (G.S.O.) of Alcoholics Anonymous. ...
... As described in greater detail elsewhere (Garcia et al., 2017;Pagano et al., 2016), the anexo program begins with detoxification, if needed, on-site or at a local hospital in acute cases. Afterwards, the residents "work" the AA program in a highly-structured residential setting with specified times for waking, sleeping, consuming meals, and performing daily chores. ...
Full-text available
This article examines the anexo’s use of Latino culture and shared experiences to promote recovery and its appeal to 1.5- and second-generation Latinos. Anexos are grassroots recovery groups with origins in Mexico that offer a residential Alcoholics Anonymous program in Latino communities. Data were gathered from a two-year (2014–2016) ethnographic study of anexos in Northern California and were analyzed thematically. Despite having access to publicly funded treatment, many 1.5- and second-generation Latinos accessed anexos based on cultural familiarity, shared experiences, and a desire to recuperate cultural practices lost during their substance use.
... For example, literature has documented some use among Latinx populations of anexos, which are community-based recovery homes that draw on AA principles and provide care to primarily male Latinx migrants and immigrants. 84,85 Regardless, these disparities raise questions as to whether existing recovery-related services are sufficient to support recovery for Latinx populations. ...
Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining "self-help" attendance. Across studies, racial/ethnic comparisons yielded mostly null (N = 17) and mixed (N = 9) effects, though some findings were consistent with a racial/ethnic disparity (N = 6) or minority advantage (N = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.
... In immigrant urban Hispanic/ Latinx communities in California, anexos are an indigenous adaptation of AA, typically catering to male, lower-income, Spanish-speaking immigrants and migrants. 37,38 Residences literally annexed to AA meeting sites, anexos originated in Mexico in 1975 as part of the recovery support "24 Hour Movement" (Movimiento 24 Horas), and since have spread to Hispanic/Latinx communities in the United States. Although strides have been made toward the cultural and linguistic adaptation of AA by minority groups, these advances have been limited by an emphasis on heterosexual men; thus, a critical next step is the adaptation of AA for minority women and for intersectional individuals with both racial/ethnic and sexual minority status. ...
Special emphasis populations in the current context can be defined as groups experiencing health disparities resulting in elevated risk to health, safety, and well-being from drinking alcohol. Individuals from marginalized minority populations often encounter barriers to accessing and receiving effective alcohol treatment due to social inequities and disadvantaged life contexts, which also may adversely affect recovery from alcohol use disorder (AUD). Recovery from AUD often involves the adoption of a stable non-drinking lifestyle (sobriety), increased health and well-being, and increased social connection. Although there has been considerable work on AUD epidemiology among special emphasis populations, little research exists directly examining recovery among racial/ethnic minority populations and/or sexual and gender minority populations. The current narrative review hopes to spark scholarly interest in this critically neglected area. This article opens with a review of special emphasis populations and their alcohol-related risks. Next, definitions of recovery, Alcoholics Anonymous, and culturally adapted recovery models for racial/ethnic minority populations are explored. This is followed by a discussion of factors that may particularly influence recovery among marginalized minority populations. This narrative review concludes with a discussion of research priorities for promoting health equity through studies focused on understanding and supporting recovery from AUD among marginalized minority populations.
This narrative literature review addresses grassroots interventions for alcohol use disorders as practiced in Mexican immigrant communities. These organic efforts are 24-hour AA groups, or anexos, fourth and fifth step AA groups, juramentos, and curanderismo. Literature was identified using PubMed and CINAHL and limited to works published from 2000 to 2018. In all, three publications on 24-hour groups were found, two on fourth and fifth step groups, four on juramentos, and one on curanderismo use. The review offers insight on their practices and concludes that the interventions’ cultural resonance provides advantages over cultural competency AUDs programs developed in public health.
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Background: Anexos are community-based recovery houses that were created in Mexico to serve people struggling with addiction to alcohol and other drugs. Brought to the U.S. by Mexican migrants, anexos provide residential care to primarily male Latino migrants and immigrants who are unable or unwilling to access formal treatment. While some Mexican anexos have come under fire for coercion, confrontational treatment methods, and corporal punishment, little is known about treatment practices in U.S. anexos. Methods: We conducted a two-year ethnographic study of three anexos in urban Northern California. The study included over 150h of participant observation and semi-structured interviews with 42 residents, 3 directors, 2 assistant directors, and 3 former directors (N=50). Qualitative data were analyzed thematically using ATLAS.ti software. Results: The anexos in our study differed in important ways from Mexican anexos described in the scientific literature. First, we found no evidence of corporal punishment or coercive internment. Second, the anexos were open, allowing residents to leave the premises for work and other approved activities. Third, the anexos were self-supported through residents' financial contributions. Fourth, collective decision-making processes observed in the California anexos more closely resembled sober living houses than their authoritarian counterparts in Mexico. Conclusion: Anexos may operate differently in the U.S. versus Mexico due to variations in sociopolitical context. This exploratory study suggests that anexos are addressing unmet need for addiction treatment in U.S. Latino immigrant and migrant communities. As a community-created, self-sustained, culturally appropriate recovery resource, anexos provide important insights into Latino migrants' and immigrants' experiences with substance abuse, help-seeking trajectories, and treatment needs.
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Informal, coercive residential centers for the treatment of addiction are widespread and growing throughout Latin America. In Mexico these centers are called “anexos” and they are run and utilized by low-income individuals and families with problems related to drugs and alcohol. This article draws on findings from a 3-year anthropological study of anexos in Mexico City. Participant observation and in-depth interviews were used to describe and analyze anexos, their therapeutic practices, and residents’ own accounts of addiction and recovery. Our findings indicate that poverty, addiction, and drug-related violence have fueled the proliferation of anexos. They also suggest that anexos offer valuable health, social, and practical support, but risk exacerbating the suffering of residents through coercive rehabilitation techniques. Emphasizing this tension, this article considers the complex relationship between coercion and care, and poses fundamental questions about what drug recovery consists of in settings of poverty and violence.
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Latinos are exposed to adverse psychosocial factors that impact their health outcomes. Given the heterogeneity and rapid growth of this population, there is an urgent need to understand the mechanisms through which psychosocial factors impact substance abuse and anxiety between immigrant and U.S. born Latino adults. The present study employs a multi-group path analysis using Mplus 7.2 to examine generational differences in the paths between affiliation culture, years of formal education, contact with important people, and length of full-time employment to substance abuse and anxiety in immigrant and U.S. born Latino adults who completed substance abuse treatment. A total of 131 participants (Mage= 36.3, SD ± 10.5, 86.3% males, 48.1% non-U.S. born with a mean length of stay of 19 years in the U.S. (SD ± 13.71) in recovery from substance abuse completed self-report measures. Results from the multi-group path analysis suggest that being more affiliated to the U.S. culture is associated with substance abuse, whereas years of formal education and longer full-time employment is associated with reduced anxiety in the immigrant group. Conversely, frequent contact with important people and affiliation to the U.S. culture are associated with fewer years of substance abuse, whereas longer full-time employment is associated with substance abuse in the U.S. born group. Anxiety and substance abuse was correlated only in the U.S. born group. The implications of these findings are discussed.
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Purpose – The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses. Design/methodology/approach – A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n=39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome. Findings – Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions. Research limitations/implications – Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally run residential integrated treatments for justice involved persons who have dual diagnoses. Social implications – Results support the utilization of low-cost, community-based treatments for a highly marginalized population. Originality/value – Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.
The grounded theory approach to doing qualitative research in nursing has become very popular in recent years. I confess to never really having understood Glaser and Strauss' original book: The Discovery of Grounded Theory. Since they wrote it, they have fallen out over what grounded theory might be and both produced their own versions of it. I welcomed, then, Kathy Charmaz's excellent and practical guide.