This thesis is an investigation into ways of seeing 12 Step fellowships. The latter provide a popular but controversial means of recovery from various addictive behaviours. The conceptual basis of 12 Step fellowships is the idea that addictions are an illness or disease, and this idea has become the focus of the negative critiques of 12 Step fellowships. Concepts of illness and disease are closely related to concepts of personhood. What 12 Step discourses construct as 'illness' can also be understood as a condition characterised by failure of human capacities for agency, choice, and responsibility. How we understand 12 Step discourses of addiction, illness, and recovery will depend greatly upon the concepts of personhood, illness, and knowledge that inform our view. In order to investigate the concepts that make diverging views of 12 Step fellowships possible, this study develops post-Enlightenment concepts of personhood, illness and knowledge. I use these concepts as a lens with which to examine the negative critiques, and to provide a more positive reading of 12 Step fellowships and illness concepts. In doing so, this thesis aims to show, first, that a positive view that can articulate the value of 12 Step fellowships to 12 Step members is possible, and second, that 12 Step fellowship discourses are philosophically interesting and challenge modern western notions of the self and its capacities. The thesis has six chapters. Chapter One presents an overview of the study, and introduces the basic concepts and practices of 12 Step fellowships. Chapter Two presents an epistemology called perspectivism which provides my research methodology as well as a means of analysing the epistemological assumptions at work in the negative critiques of 12 Step discourses. In order to understand how the capacities of the self may fail, and how such failures might be remedied, Chapter Three presents a post-Enlightenment theorisation of personhood as constituted, embodied, and socially embedded subjectivity. This theorisation enables us to examine how embodied selves may be constituted with diminished capacities for agency, responsibility, and choice, and permits the construction of an account of addiction that explains why addictive disorders are a significant social problem in contemporary western societies. Finally, this theorisation enables us to investigate the concepts of personhood that inform the negative critiques. Chapter Four investigates how concepts of illness inform the negative critiques, and shows that it is possible to understand terms such as 'illness' and 'disease' in a non-medical sense. Arguably, such understandings are better able to illuminate the connection between the notion of illness and recovery practices in 12 Step discourses of addiction. Chapter Five uses the conceptual framework provided by Chapters Two, Three, and Four to present a positive view of 12 Step fellowships and discourses. The three key features of this view are, first, that 12 Step fellowship discourses describe addictions as an illness of the self; second, they provide a phenomenology of the sick self; and third, 12 Step recovery discourses and practices are consistent with the notion that the constituted self is limited, and can be reconstituted or changed through practice of the 12 Step recovery program. Together, these three key features show us that 12 Step fellowships provide a valuable social resource for people with limited capacities for self-regulation to help themselves and each other. Chapter Six considers the implications of this more positive view of 12 Step fellowships in terms of the primary and secondary aims of this thesis.

Twelve step organizations such as Alcoholics Anonymous and Narcotics Anonymous are free, community-based fellowships. Such organizations are the most widely sought recovery management options, surpassing professional treatment. The emerging evidence base suggests that involvement in such organizations is associated with positive substance-related outcomes (e.g., abstinence). Relatively speaking, however, far less is known about whether or not involvement is associated with other meaningful psychosocial constructs. The current study examined gratitude, meaning in life, life satisfaction, personal growth, and various other recovery and psychosocial constructs in a sample of self-identified NA members (N = 128) from 26 U.S. states, ranging in age from 22 to 64 years. The primary aim of the present study was to psychometrically evaluate and refine four distinct positive psychology instruments (i.e., Gratitude Questionnaire (GQ – 6), Meaning in Life Scale (MLQ), Satisfaction With Life Scale (SWLS), Personal Growth Initiative Scale (PGIS)). The current study contained three phases. First, the psychometric properties of each instrument were examined within an Item Response Theory measurement framework. The Rating Scale Model was used to evaluate the each instrument using WINSTEPS 3.74.01. With the exception of the Meaning in Life Questionnaire (which did not conform to an IRT measurement model), each instrument was iteratively refined based on statistical and clinical considerations, resulting in the collapse of response options and the removal of poorly fitting items. These refinements improved the psychometric properties of each instrument, resulting in a more reliable, accurate, and efficient way to measure gratitude, life satisfaction, and personal growth in clinical samples. Second, items from the GQ – 6, SWLS, and PGIS were examined concurrently using the PROC IRT procedure in SAS to explore whether the constructs were distinct from one another. Results provide support that gratitude, life satisfaction, and personal growth are unique and distinct constructs. Last, the study examined several recovery-related correlates of gratitude, life satisfaction, and personal growth. Hierarchical regression models assessed whether abstinence duration and other recovery-related variables accounted for significant incremental variance in gratitude, life satisfaction, and personal growth, over and above several covariates. As a block, abstinence duration and recovery predictors accounted for significant incremental variance in all of the constructs. These data suggest ongoing recovery involvement in 12-step organizations may be associated with positive outcomes beyond abstinence. Limitations and directions for future research are discussed.

In the following essay, I will present my fieldwork that I've conducted in Radhakund India. For three weeks I was living in a hindu monastery (eg. ashram) that primarily houses a group of swedes who have formerly suffered from substance-abuse and have gone through medical detoxification, rehabilitation and 12-step treatment. They have all eventually taken up the religious/spiritual practice that the monastery focuses on; meditative and ritual practice in the tradition of gaudiya-vaishnavism. The monastery, namned Bhajan Kutir Ashram, was formed by the psychologist and author Torbjörn Fjellström, who himself is a practitioneer of gaudiya-vaishnavism. Besides rituals and meditation, pilgrimage to Radhakund is part of the religious practice and tradition these people adhere to. My ambition has been to investigate if their religious/spiritual practice in this tradition has been helpful in their recovery. My conclusion is that they have recovered through the cognitive and emotive tools, analytically called Sense of Coherence (SOC) that are found both in the 12-step treatment and the gaudiya-vaishnava-tradition. While the 12-step treatment has helped the respondents to recover from substance-abuse, their religious/spiritual practice in the context of gaudiya-vaishnavism is seen as a natural continuation of the 12 steps and a deepening of its principles. Another theoretical conclusion drawn from the material is that the way the respondents describe recovery, is practically impossible to separate from their religious/spiritual practice and perspectives.

Previous research on self-change in support groups has focused on the ways individuals accomplish self-change in the "local cultures" of the support group settings. This ethnographic study of the 12-step self-help group Debtors Anonymous (DA) departs from that tradition by focusing on the ways that DA members achieve self-change by employing "recovery" strategies learned from the group in their everyday lives. DA members enter the group during financial crises, and often believe they cannot manage their own personal finances. By learning techniques of financial management taught by the group, DA members gradually gain "sobriety" and financial management skills. This analysis highlights the important role played by various technologies of self-construction in DA members' recovery efforts. Drawing on narrative and governmentality theories, this analysis shows how DA members accomplish self-change by learning to become self-monitoring and self-restrained financial managers and consumers.

Women suffer methamphetamine (meth) addiction at a rate much higher than rates for addiction to other drugs. Female meth users are susceptible and predisposed to gender-related risks: high rates of unprotected vaginal and anal sex, sex-work, and sexual coercion. Precursors for addiction (e.g., abuse, body dysphasia) put females in a difficult position for recovery and highlight the need for gender-specific research and treatment. Methamphetamine (a synthetically derived stimulant) creates psychological and physical dependency that affects every neuron of the brain and damages the body immediately. Women ingest meth for initial effects that allay social pressures: feeling euphoric, connecting with others during ―parties,‖ losing weight, boosting energy, and feeling ―normal‖ despite tumultuous living conditions. Meth‘s aphrodisiac properties improve sexual relations, at least until addiction sets in, at which time relationships frequently become exploitive or abusive. Eventually, meth‘s positive effects turn negative, resulting in poor psychological and physical health. Meth addicts experience hallucinations, insomnia, and deteriorating relationships with family, friends, and colleagues. Physically, they suffer gauntness, deterioration of teeth and gums, and skin formication. They often undergo abuse to sustain their addictions. This study analyzes quantitative data from the National Household Survey to frame the reflective ethnographic portion‘s interactive interviewing and introduces a new tool, the Life Time Line, to clarify and correlate life events. The ethnographic results, based on extensive life history interviews with five women in recovery from methaddiction, concur with national trends and detail themes that could inform prevention and treatment programs. Recurrent themes are: dysfunctional parental relationships (including being ―adulterized‖) and chaotic childhood; a full range of abuse by parents, family, and husbands or boyfriends; introduction to drugs by males; body image dysphasia; and feelings of normalcy on drugs or self-medication in the face of unbearable living conditions or mental illness.This study emphasizes recovery. The ethnographies reveal that each woman had an epiphany, at least partially facilitated by a recovering addict; participated fully in a 12-step program such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA); became dedicated to the acquisition of a college education, including graduate school; and attend AA or NA to maintain sobriety.

Substance use disorders (SUDs) affect a significant portion of the population and are noteworthy public health concerns. Mutual help organizations (MHOs) such as Alcoholics Anonymous and Narcotics Anonymous are considered evidence-based practices for SUDs. Despite a growing body of research examining mechanisms of change in MHOs, relatively few investigations of 12-step organizations have been theory-driven. Theory-based models of recovery provide a more comprehensive view of the range of individual factors affecting individuals in recovery and how and why they might engage in recovery-related behaviors. Stress and coping theory fills a gap in explaining how improvements occur as a result of MHO recovery engagement from a bio-psycho-social perspective. Although some recovery program-related mechanisms of change in MHOs have proven to be important factors in promoting long-term recovery from SUDs, fewer studies have examined what factors may influence participation in recovery practices. Using a sample of community-based Narcotics Anonymous members from 26 U.S. states, the relationships between stress and engagement in various recovery practices are examined from the perspective of a psychobiological, SUD-specific stress and coping framework. It is hypothesized that the relationship between stress and recovery practice engagement is moderated by abstinence duration, such that individuals at lower levels of abstinence duration would have fewer coping resources to mitigate stress and therefore would evidence a greater association between stress and engagement in higher levels of recovery practices. Results indicated the stress-recovery practice involvement relationship was not moderated by abstinence duration, and stress was not significantly associated with any recovery practices. However, helpfulness of social support received from individuals in recovery, abstinence duration, neuroticism, and substance use severity all significantly predicted recovery practice involvement. Gaining additional understanding of mechanisms that influence recovery involvement will allow clinicians and researchers to enhance interventions and facilitate involvement in beneficial aspects of recovery programs.

Approximately 10% of adults living in the United States meet criteria for a Substance Use Disorder. Although 12-step groups are considered evidence-based practices for substance use problems, an understanding of the underlying mechanisms by which they facilitate recovery practices remains in its infancy. The purpose of the current study was to explore whether attachment could be considered a possible mediator of the effects of recovery practices on positive psychosocial outcomes. Participants (N = 112) were self-identified NA members from 26 U.S. states who completed an online survey assessing attachment style, psychosocial sense of community, psychological well-being, and various other recovery and psychosocial constructs. Results indicated a number of recovery-related practices emerged as significant predictors of secure attachment, over and above covariates. For example, higher levels of home group comfort were associated with increased probability of secure attachment classification (by self-report). In general, psychological sense of community did not significantly predict secure attachment, over and above covariates. Although attachment predicted psychological well-being in univariate models, it generally failed to predict psychological well-being in models that included covariates and recovery-related predictors. Theoretically, these data suggest that functional social support variables are primary recovery-related predictors implicated in NA-involvement, above and beyond other structural social support variables. This further suggests that attachment-related dimensions of 12-step interventions may be integral to recovery outcomes.

Obesity has become a worldwide epidemic and limiting one's food intake, or dieting, is usually unsuccessful. The purpose of the study was to explore the effect of food addiction (FA) on the current clinical and behavioral epidemic of obesity. FA, synonymous with food-dependency, is tentatively defined as an eating disorder based on substance dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders. Measurement of FA has been operationalized by the Yale Food Addiction Scale (YFAS) by applying the diagnostic criteria of substance dependence to eating behaviors. This study was based on the biological theory of chemical addiction and the evidence that highly processed, high-fat, and high-sugar foods may be addictive and may contribute to unsuccessful dieting. To explore the difficulty of adhering to healthy food choices, 6 women were identified who satisfied the diagnostic criteria of FA using the YFAS. These women were invited to participate in a qualitative study. The full transcripts, which were coded via interpretative phenomenological analysis, revealed 6 major themes. The most salient master themes were the loss of control over food intake, the need for external control for successful weight loss, and the significant distress caused by food and eating. All the women interviewed agreed that FA is an eating disorder and that (a) best results were obtained from sugar and flour abstinence and (b) success was found in a 12 Step program for FA based on an addiction model. Once identified with the YFAS, FA has a large impact for social change. Those recognized as having a FA can be offered a specific treatment, based on an addiction model, which differs from the usual treatment for obesity and offers a solution for successful weight management.

Substance use disorders represent a consistent threat to our health care and financial resources. Although mental health professionals are likely to encounter individuals diagnosed with substance use disorders, they are less likely to receive formal graduate training in the area. Furthermore, 12-step groups like Alcoholics Anonymous and Narcotics Anonymous are popular, evidence-based recovery options, yet little is known about perceptions of such groups among clinical trainees. In addition, quantitative evaluations of substance use training modules have seldom been conducted, including a notable lack of methodologically rigorous approaches. To fill these gaps in the literature, the current study examined the efficacy of a brief computer-mediated training intervention, or e-training, designed to increase future clinicians' knowledge and intentions to engage in 12-step-related professional activities (e.g., making an appropriate referral to a 12-step group). Secondary outcomes were beliefs and attitudes about 12-step groups. Fifty participants were randomly assigned to receive the e-training, a brief audio/visual presentation reviewing 12-step recovery philosophy but focusing on academic 12-step literature. Fifty-three participants were randomly assigned to read comparison materials, which were comprised of online readings geared toward professionals, made available by Alcoholics Anonymous and Narcotics Anonymous. Outcomes were assessed at pretest, posttest (i.e., immediately following exposure to intervention or comparison materials), and 4-week follow-up periods. Results of random effects regression analyses showed that the e-training led to significantly greater increases in 12-step recovery knowledge than comparison readings, and that these gains were maintained through follow-up. An intervention effect on intentions to perform 12-step-related professional activities also emerged by follow-up. Exploratory moderation analyses revealed that the intentions effect was more pronounced for women and for trainees who had never attended a 12-step meeting. Secondarily, the e-training led to significantly greater increases in 12-step-positive beliefs and attitudes, though the beliefs effect attenuated by follow-up. Taken together, these data suggest that future clinicians may benefit from a brief e-training about 12-step recovery. More broadly, the study supports the notion that e-trainings are easily disseminated and may help address current limitations in graduate-level substance use clinical training.

This study qualitatively investigated the processes and outcomes associated with the The Church of Jesus Christ of Latter-day Saints’ (LDS) Addiction Recovery Program (ARP), with a specific focus on their Pornography Addiction Support Group (PASG) meetings. Researchers interviewed 24 (21 males, 3 females) individuals with varying experiences in PASG meetings. Their interview content was broken down into themes. Primary findings suggest that PASG participants experience a significant amount of shame due to their pornography use behaviors. Member-to-member sharing in meetings facilitates self-compassion and lessens shame. Participants reported strong spiritual process in PASG meetings and some spiritual outcomes. Attendance in PASG meetings impacts the way participants viewed their treatment conceptualization, problematic pornography use (PPU) behaviors, self, and God. Further, negative aspects of PASG meetings include the use of an addiction model, a focus on PPU behaviors, and some shaming experiences.