My good friend Michael Scott, of Michael’s Recovery Story, and I attended a Public Awareness Meeting of Alcoholics Anonymous (AA) in a Perth suburb today. I was asked to talk for five minutes about my recovery work over the years. I also described some of the factors that facilitate recovery.
We listened to a number of AA members share their stories and I have to say that I was blown away by the high quality of the shares. They were moving, inspirational and insightful. More women than men spoke. It was such a good meeting and I really enjoyed talking to people after the actual meeting ended.
Imagine my surprise when I got home to find that my good friend Dr David McCartney had just uploaded a blog post about women, drinking and recovery.
David, who is in recovery from an alcohol use disorder, is clinical lead for LEAP (Lothians & Edinburgh Abstinence Programme), a three month, quasi-residential, treatment programme for people with alcohol and drug dependency. When I lived in the UK, I visited LEAP a number of times, learning a lot from staff and clients, and enjoying myself thoroughly.
What David had to say in his new blog really resonated with me, given what I heard from the women who shared today. I have to post David’s words here because I believe what he has written is so important.
‘Recovery: a lived experience of improved life quality and a sense of empowerment.’ Best & Laudet
When it comes to drinking problems, men and women have differences. Women tend to binge, have higher pre-existing trauma levels and can suffer more (or different) kinds of stigma and discrimination. They are also more vulnerable to physical complications and have greater mental health co-morbidity. Alcohol-related mortality is higher. In my work I’m seeing more young women with alcoholic cirrhosis of the liver than ever before – a worrying trend.
Gender norms and societal expectations often result in stigmatisation when the ‘alcoholic woman’ deviates or is unable to fulfil prescribed gender roles (i.e. wife, mother). Such stigmatisation results in a reluctance to ask for help.
Women and recovery
Recovery can also be different. Women face barriers to treatment. Issues around childcare and fear of losing custody, domestic violence, trauma and unemployment can act as deterrents. In addition, it has been found that some services are more tailored to men than women. Recovery capital resources may be less available to women who can experience ‘oppressive experiences of social control’.
Wanting to know more
It’s really good to see alcohol research focussing on women. Zetta Kougiali, Alicia Pytlic and Kirstie Soar took a look [1] at qualitative studies which examined women’s pathways into dependence and then into recovery. They quote the Best and Laudet [2] description of recovery as ‘a lived experience of improved life quality and a sense of empowerment’.
The authors wanted their study to offer valuable knowledge towards understanding the different needs, mechanisms, and factors that can facilitate or hinder women’s recovery.
The research
They examined 23 published studies, including one from Scotland. They identified 4 themes.
1. The pre-drinking ‘self’
Kougiali and colleagues found that women linked trauma and victimisation experiences (e.g., childhood sexual abuse, growing up in abusive families, emotionally absent parents) in earlier life to the development of their drinking problems. These experiences had generated intense shame and feelings of not belonging, inadequacy and inferiority.
The experience of having to conform to gender norms, feeling choices were limited and lack of ability to allow the ‘real self’ to emerge were all cited as relevant.
2. Alcohol as a corrective agent
Drinking was used as a technique to ‘correct’ negative feelings through the creation of a ‘substitute self’, a ‘substitute reality’ and temporary empowerment.
3. Escalation of drinking and the dependent self
Although alcohol was initially used to ease the difficulties, a tipping point came when this could not be maintained. Paradoxically, the use of alcohol started to create the same problems that it had been used to tackle, resulting in despair and hopelessness linked to shame and stigma. A sense of being trapped developed.
4. The recovering self
The process of recovery happened when power was transferred from external things, like alcohol and other people, back to ‘the self’. Although turning points varied, they were connected in the sense that a belief that drinking was no longer sustainable developed. The authors say, ‘Participation in recovery groups helped gradually move from concealing perceived problematic aspects of personality to increased self-expression, sense of belonging, and empowerment.’
Going to recovery meetings also helped develop a social network that countered the loneliness and emptiness that can accompany early recovery.
‘Women’s accounts revealed their understanding of recovery groups as spaces of collective as well as individual empowerment.’ Kougiali et al, 2021
According to Krenzman et al [3], women make up a third of Alcoholics Anonymous membership and do better than men in terms of outcomes. However, for women attending AA meetings there can be controversy over the concept of powerlessness. In this study, participants identified powerlessness as a helpful concept, as they did other features of the AA programme, such as self-awareness and self-reflection, group membership (sense of community and belonging) and sponsorship (sense of connection).
There were benefits to attending women-only meetings, though interestingly, most women stressed the importance of attending mixed meetings too, even though some women experienced distress when disclosing their past in mixed meetings. This led the authors to suggest that women with adverse experiences and those in early recovery should be ‘informed both of the implications and potential benefits of participating in mixed-gender meetings’.
Summary
“Alcohol was initially used as a corrective agent and as a tool of temporary empowerment, regulating structural and familial imbalances. However, drinking became progressively compulsive and overpowered every aspect of life. Initiation of recovery was often hindered by shame and stigma and facilitated by belonging to and being accepted by recovery groups and a revision of ‘the self’ within wider social structures.”
Continue the discussion on Twitter: @docDavidM
Photo credit: fizkes/istockphoto. Under license
[1] Zetta G. Kougiali, Alicja Pytlik & Kirstie Soar (2021) Mechanisms and processes involved in women’s pathways into alcohol dependence andtowards recovery: a qualitative meta-synthesis. Special issue on mechanisms and mediators of addiction recovery, Drugs: Education, Prevention and Policy, DOI: 10.1080/09687637.2021.1904836
[2] Best, D., & Laudet, A. (2010). The Potential of Recovery Capital. Royal Society of Arts.
[3] Krentzman AR, Brower KJ, Cranford JA, Bradley JC, Robinson EA. Gender and extroversion as moderators of the association between Alcoholics Anonymous and sobriety. J Stud Alcohol Drugs. 2012 Jan;73(1):44-52.
Thanks so much for this excellent blog post, David. You can see David’s original post here. Please share, as this information needs to reach a wide audience.
