"La ruptura en el cuidado": Experiencias de mujeres madres con abuso de alcohol y su atención en México / "The break in care": Mothers' experiences with alcohol abuse and care in Mexico

RESUMEN Este artículo se propone analizar las experiencias sobre la maternidad y los cuidados de mujeres madres que asisten a grupos de apoyo mutuo en la Ciudad de México y el Estado de México para autoatender los daños asociados al alcohol. A partir del marco conceptual de la salud colectiva y la perspectiva de género, se concibe que la condición de género y socioeconómica inciden en la determinación social del alcoholismo y en el proceso salud-enfermedad-atención-cuidado. Desde este enfoque, de mayo de 2020 a enero de 2021, se realizó un estudio cualitativo, en el que se entrevistó a diez mujeres elegidas bajo ciertos criterios y se realizó observación no participante en un grupo femenino Alcohólicos Anónimos. Entre los principales resultados, se reconoce una trayectoria de abuso de alcohol y su atención, concatenada con la trayectoria de cuidados. Este hallazgo delimitó la categoría de "ruptura en el cuidado" para develar el maltrato, la precarización de vida y salud de las mujeres y sus hijos e hijas.

ABSTRACT This article aims to analyze the experiences related to motherhood and care among mothers who attend mutual support groups to address alcohol-related harm in Mexico City and the State of Mexico. Drawing on the conceptual framework of collective health from a gender perspective, we contend that socioeconomic and gender-related factors influence the social determination of alcoholism and the health-disease-attention-care process. A qualitative study was conducted between May 2020 and January 2021, which included interviews with ten women who were selected based on specific criteria, as well as non-participant observation in a women's Alcoholics Anonymous group. The main findings show how trajectories of alcohol abuse and its management are interconnected with trajectories of care. From there, it was possible to identify a "break in care," a category that sheds light on mistreatment and the precariousness of life and health of women and their children.

Significados do alcoolismo em uma reunião feminina de Alcoólicos Anônimos na cidade de São Paulo, SP, Brasil / Meanings of alcoholism in a women-only Alcoholics Anonymous in São Paulo, SP, Brazil / Significados del alcoholismo en una reunión femenina de Alcohólicos Anónimos en la ciudad de São Paulo, SP, Brasil

O objetivo deste artigo é compreender os significados do alcoolismo de uma maneira êmica, isto é, tal como ele é concebido e vivenciado por mulheres que frequentam uma reunião feminina de Alcoólicos Anônimos (AA). Realizou-se uma pesquisa qualitativa, de abordagem etnográfica, em uma reunião exclusiva de mulheres em um grupo localizado na cidade de São Paulo, Brasil. O alcoolismo está ligado às assimetrias de gênero, que estabelecem uma diferença entre homens e mulheres em relação ao uso de bebidas alcoólicas, de modo que a reunião feminina de AA possui uma dimensão política que se contrapõe à cultura patriarcal de AA ao garantir às mulheres um espaço de gênero, moral e politicamente, privilegiado para que elas possam compartilhar e significar suas experiências e, por essa via, realizar seu tratamento do alcoolismo.(AU)

The aim of this emic study of alcoholism was to understand how this problem is conceived and experienced by women attending a women-only Alcoholics Anonymous (AA) meeting. We conducted an ethnographic study with a women's AA group in São Paulo, Brazil. Alcoholism is linked to gender asymmetries, which establish a difference between men and women in relation to drinking. Women-only AA meetings therefore possess a political dimension that counterposes AA's patriarchal culture by providing women with a morally and politically unique gendered space that allows them to share and signify their experiences and, in this way, treat their alcoholism.(AU)

El objetivo de este artículo es comprender los significados del alcoholismo de una manera émica, es decir, tal como es concebido y vivido por mujeres que frecuentan una reunión femenina de Alcohólicos Anónimos (AA). Se realizó una investigación cualitativa, de abordaje etnográfico, en una reunión exclusiva de mujeres en un grupo localizado en la Ciudad de São Paulo, Brasil. El alcoholismo está vinculado a las asimetrías de género que establecen una diferencia entre hombres y mujeres con relación al uso de bebidas alcohólicas, de modo que la reunión femenina de AA tiene una dimensión política que se contrapone a la cultura patriarcal de AA al asegurar a las mujeres un espacio de género, moral y políticamente privilegiado para que ellas puedan compartir y significar sus experiencias y, por esa vía, realizar su tratamiento del alcoholismo.(AU)

O laço social na construção identitária do alcoólico anônimo / The social bond in the construction of the anonymouns alcoholic's identity / El vínculo social en la construcción de la identidad del alcohóloco anónimo

A diversidade de grupos anônimos no âmbito social compõe um panorama maior de coletivos identitários que reivindicam sua diferença e distinção social. Considerando a primazia histórica da Irmandade Alcoólicos Anônimos (AA), este artigo discute a construção identitária e social do alcoólico anônimo. Recorremos à literatura oficial da Irmandade como fonte de dados e à teoria psicanalítica como referencial teórico para a análise dos resultados. Constatamos que a construção identitária do alcoólico anônimo se estabelece a partir de um engajamento a Irmandade, sendo seu funcionamento pautado nos ideais de fraternidade, anonimato e abstinência alcoólica. Entre os AA, a identificação sintomática com o alcoolismo pressupõe o vínculo fraternal, funcionando como uma reparação imaginária no trabalho de construção do alcoolista anônimo. Concluímos que a produção identitária "alcoólico anônimo" consiste na adesão a uma nova forma de vida, cujos efeitos são de segregação ao laço social e de alienação ao Outro institucional (AU).

In contemporaneity, the presence of several anonymous groups composes a diverse set of identity groups that claim their difference and distinction. Considering the historicity of the Brotherhood of Alcoholics Anonymous (AA), this article analyzes the identity construction of the anonymous alcoholic and its relationship with the social bond. We used the official literature of the Brotherhood as a data source and the psychoanalytic theory as a theoretical reference for the analysis of the results. We find that the identity construction of the anonymous alcoholic establishes, in principle, from an institutional engagement to the AA, being its operation based on the ideals of brotherhood, anonymity and alcohol abstinence. Among AA the symptomatic identification with the alcoholism disease occurs concomitant to the establishment of the fraternal bond that functions as an imaginary and egoic repair for the alcoholic in his work of identity production. We conclude that the "anonymous alcoholic" identity construction is equivalent to the purpose of the therapeutic proposal of AA that consists in the adhesion to a new way of life, whose effects are of segregation to the social bond and of alienation to the Institutional Other (AU).

En nuestra era contemporánea, la presencia de innumerables grupos anónimos constituye un panorama diverso de grupos de identidad que reclaman su diferencia y distinción. Considerando la primacía histórica de la Hermandad Alcohólicos Anónimos (AA), este artículo discute la construcción de identidad del alcohólico anónimo y su relación con el vínculo social. Utilizamos la literatura oficial de la Hermandad como fuente de datos y la teoría psicoanalítica como marco teórico para el análisis de resultados. Descubrimos que la construcción de la identidad del alcohólico anónimo se establece, al principio, a partir de un compromiso institucional con AA, y su funcionamiento se basa en los ideales de fraternidad, anonimato y abstinencia de alcohol. Entre los AA, la identificación sintomática con el alcoholismo de la enfermedad ocurre simultáneamente con el establecimiento del vínculo fraterno que funciona como una reparación imaginaria y egoica para el alcohólico en su trabajo de construcción de identidad. Concluimos que la producción de identidad "alcohólica anónima" es equivalente al propósito de la propuesta terapéutica de AA, que consiste en adherirse a una nueva forma de vida, cuyos efectos son la segregación del vínculo social y la alienación del Otro institucional (AU)

Alcoolismo: impactos na vida familiar / Alcoholism: impacts on family life / Alcoholismo: impactos en la vida familiar

OBJETIVO: identificar os problemas acarretados pelo consumo excessivo do álcool, bem como as consequências que ele traz à família. MÉTODO: o instrumento utilizado foi uma entrevista semiestruturada, com roteiro composto por 12 questões elaboradas pelos próprios pesquisadores, para responder às temáticas propostas. Para a análise das entrevistas, utilizou-se a Análise do Conteúdo e, como ferramenta de análise, empregou-se o software NVivo11, destinado ao tratamento de dados em investigação qualitativa. RESULTADOS: durante o tratamento das entrevistas, elaboraram-se uma árvore categorial, que apresenta o álcool como núcleo, e quatro nós categoriais como aspectos principais da entrevista, sendo eles: início do uso; consequências para a família; problemas pelo consumo excessivo e ajuda. CONCLUSÃO: podem-se depreender as consequências negativas que o uso excessivo do álcool gera para as relações familiares, sendo este o eixo da vida de um alcoolista mais devastado. Além disso, é importante salientar que o mesmo eixo familiar destruído é base para a retomada de uma mudança como respaldo para a procura de auxílio de entidades competentes, como os Alcóolicos Anônimos.

OBJETIVO: conocer la realidad del alcohólico e identificar los problemas causados por el consumo excesivo de alcohol, así como las consecuencias que trae a la familia. MÉTODO: el instrumento utilizado fue una entrevista semiestructurada con un guión compuesto por 12 preguntas, preparadas por los propios investigadores, para responder a los temas propuestos. Para el análisis de las entrevistas, se utilizó el Análisis de contenido y, como herramienta de análisis, el software NVivo11 para el procesamiento de datos en la investigación cualitativa. RESULTADOS: durante el tratamiento de las entrevistas fue posible elaborar un árbol categórico que presenta el alcohol como núcleo y cuatro nodos categóricos como los aspectos principales de la entrevista, a saber: comienzo del uso; consecuencias para la familia; problemas de consumo excesivo y ayuda. CONCLUSIÓN: uno puede entender las consecuencias negativas que el uso excesivo de alcoholico genera para las relaciones familiares, siendo este eje de la vida de un alcohólico el más devastado. Además, es importante tener en cuenta que el mismo eje familiar destruido es la base para la reanudación de un cambio, como apoyo para la búsqueda de ayuda de entidades competentes, como Alcohólicos Anónimos (AA).

OBJECTIVE: identify the problems caused by excessive alcohol consumption, as well as the consequences it brings to the family. METHOD: the instrument used was a semi-structured interview, with a script composed of 12 questions prepared by the researchers themselves, to answer the proposed themes. For the analysis of the interviews, Content Analysis was used and, as an analysis tool, the NVivo11 software was used, aimed at processing data in qualitative research. RESULTS: during the treatment of the interviews, a categorical tree was elaborated, which presents alcohol as the nucleus, and four categorical knots as main aspects of the interview, being them: beginning of the use; consequences for the family; problems by excessive consumption and help. CONCLUSION: the negative consequences that the excessive use of alcohol generates for family relationships can be inferred, and this is the axis of the life of a more devastated alcoholic. In addition, it is important to point out that the same destroyed family axis is the basis for the resumption of a change as a support for the search for help from competent entities, such as the Alcoholics Anonymous.

Eventos estresantes, espiritualidad y consumo de alcohol en participantes del programa de 12 pasos de AA / Stressful events, spirituality, and alcohol consumption in participants of the 12-Step AA Program

Resumen El objetivo es determinar la asociación entre los eventos estresantes, la espiritualidad, la participación en el programa y el consumo de alcohol en participantes del programa de 12 pasos de AA. Método descriptivo correlacional y predictivo. La población fueron integrantes de AA, México. Se realizó un muestreo aleatorio simple por conglomerados, la muestra estuvo conformada por 72 participantes de AA con un nivel de confianza del 95%. Se utilizó la Escala de Perspectiva Espiritual y la Escala de Clasificación de Reajuste Social. Los eventos estresantes se relacionan de manera negativa y significativa con el consumo de alcohol (rs = -.316, p = .007), esto indica que mayor índice de eventos estresantes menor es la cantidad de días sin consumo de alcohol, la participación en el programa se relaciona positiva y significativamente con el consumo de alcohol (rs = .776, p = .001), esto señala que mayor años de participación mayor es la cantidad de días sin consumo de alcohol, la espiritualidad no mostró relación significativa (p > .05), además existe efecto significativo de la participación en el programa y la edad sobre el consumo de alcohol (R2 = 65.2%, p = .001). La participación en el programa de AA se relaciona y tiene efecto sobre a cantidad de días sin consumo de alcohol.

Abstract This work sought to determine the association between stressful events, spirituality, program participation and alcohol consumption in participants of the AA 12-step program. The study used a descriptive correlation and predictive method. The population was comprised by members from AA, Mexico. A simple random sampling by clusters was performed, the sample consisted of 72 AA participants with 95% CI. The Spiritual Perspective Scale and the Social Readjustment Rating Scale were used. Stressful events are negatively and significantly related to alcohol consumption (rs = −0.316, p = 0.007), this indicates that the higher the number of stressors, the lower the number of days without alcohol consumption; participation in the program was positively and significantly related to alcohol consumption (rs = 0.776, p = 0.001), which indicates that greater years of participation means greater number of days without alcohol consumption. Spirituality showed no significant relationship (p > 0.05), there is also a significant effect of participation in the program and age on alcohol consumption (R2 = 65.2%, p = 0.001). Participation in the AA program is related to and has an effect on the number of days without alcohol consumption.

Repercusión social de los grupos de Alcohólicos Anónimos en egresados del servicio de Deshabituación en provincia Guantánamo / Repercussão social de grupos de Alcoólicos Anônimos em retirados do serviço de desintoxicação na província de Guantánamo / Social repercussion of Alcoholics Anonymous groups ending of the Detoxification service in Guantanamo province

Introducción: el movimiento internacional de ayuda contra el alcoholismo Alcohólicos Anónimos, consiste en comunidades de hombres y mujeres que comparten su mutua experiencia, fortaleza y esperanza para resolver el problema del alcoholismo en común y ayudar a otros en su recuperación. Objetivo: demostrar la repercusión social de los grupos de Alcohólicos Anónimos en pacientes egresados del servicio de deshabituación del Hospital Psiquiátrico de Guantánamo durante enero y diciembre de 2016. Método: se realizó un estudio observacional, descriptivo donde se utilizó un cuestionario elaborado por los autores y validados por psicólogos. La población y la muestra estuvieron constituidas por 140 pacientes pertenecientes al municipio Guantánamo. Resultados: el sexo masculino fue el más representativo, la edad de comienzo de la ingestión de bebidas alcohólicas estuvo marcada entre los 11 y 39 años, considerando que debían recibir ayuda médica el mayor por ciento, siendo estos atendidos en el servicio de Deshabituación del hospital psiquiátrico y el Hospital de Día de alcohólicos, además de la psicoterapia de la comunidad. Los pacientes encuestados consideran que son discriminados por la sociedad. Conclusiones: el éxito de Alcohólicos Anónimos está en que todos los que pertenecen a la agrupación tienen crítica de la enfermedad y pueden compartir sus propias experiencias en la psicoterapia con un apoyo seguro y seguimiento continuo, siempre al lado de la comunidad profesional, experiencia que en Guantánamo ha ido ganando en beneficio a estos pacientes(AU)

Introduction: the international movement of help against alcoholism Alcoholics Anonymous, consists of communities of men and women who share their mutual experience, strength and hope to solve the problem of common alcoholism and help others in their recovery. Objective: to demonstrate the social repercussion of the Alcoholics Anonymous groups in patients detoxified in the service of the Psychiatric Hospital of Guantanamo during January and December 2016. Method: an observational, descriptive study was carried out where a questionnaire elaborated by the authors and validated by psychologists. The population and the sample consisted of 140 patients belonging to the Guantanamo municipality. Results: the masculine sex was the most representative, the age of beginning of the ingestion of alcoholic drinks was marked between the 11 and 39 years, considering that they had to receive medical aid the greater percent, being these attended in the service of deshabituación of the hospital psychiatric hospital and day hospital for alcoholics, in addition to community psychotherapy. The surveyed patients consider that they are discriminated against by society. Conclusions: the success of Alcoholics Anonymous is that all those who belong to the group have a critique of the disease and can share their own experiences in psychotherapy with a safe support and continuous monitoring, always at the side of the professional community, experience that in Guantánamo has been gaining benefit to these patients(AU)

Introdução: o movimento internacional contra o alcoolismo ajuda Alcoólicos Anônimos consiste de comunidades de homens e mulheres que compartilham suas experiências, forças e esperanças para resolver o problema do alcoolismo em comum e ajudar os outros em sua recuperação. Objetivo: demonstrar o impacto social dos grupos de Alcoólicos Anônimos em pacientes que receberam alta do serviço deshabituación Hospital Psiquiátrico Guantánamo em janeiro e dezembro de 2016. Método: um estudo observacional, descritivo que foi usado foi realizado um questionário elaborado pela autores e validados por psicólogos. A população e a amostra consistiram em 140 pacientes pertencentes ao município de Guantánamo. Resultados: O sexo masculino foi o mais representativo, a idade de início de consumo de álcool foi marcado entre 11 e 39 anos, considerando que eles devem receber assistência médica a maior percentagem, estes sendo tratados no hospital de desintoxicação hospital psiquiátrico e hospital-dia para alcoolistas, além de psicoterapia comunitária. Os pacientes pesquisados consideram que são discriminados pela sociedade. Conclusões: o sucesso de Alcoólicos Anônimos é que todos os que pertencem ao grupo têm doença grave e pode compartilhar suas próprias experiências em psicoterapia com o apoio seguro e monitoramento, sempre ao lado da comunidade profissional, experiência que em Guantánamo vem se beneficiando desses pacientes(AU)

A invenção dos Alcoólicos Anônimos: alcoolismo e subjetivação / The invention of Alcoholics Anonymous: alcoholism and subjectivation / La invención de los Alcohólicos Anónimos: alcoholismo y subjetivación

O surgimento do alcoolismo como categoria médica no final século XIX foi contemporânea as intervenções médicas nas massas populacionais urbanas. Mais adiante, os Alcoólicos Anônimos (AA) surgem como uma irmandade com o propósito de tratar a "doença alcoólica" partindo de preceitos metódicos e espiritualistas. Este artigo objetiva discutir a constituição histórica e genealógica dos AA, destacando seus efeitos subjetivos em torno da categoria alcoolismo. Empreendemos um estudo bibliográfico utilizando a produção escrita dos AA, analisando os dados a partir da perspectiva foucaultiana. Constatamos que os AA individualizaram o diagnóstico de alcoolismo, até então concebido como uma doença social. Concluímos que os AA reformularam a concepção de doença alcoólica dando-lhe uma conotação subjetiva e inauguraram uma terapêutica pragmática cujo efeito foi uma nova construção identitária calcada em uma moral de vida

The emergence of alcoholism as a medical category in the late nineteenth century was contemporary to medical interventions in the urban masses. Later, Alcoholics Anonymous (AA) emerged as a brotherhood for the purpose of treating 'alcoholic disease' from methodical and spiritualistic precepts. This article aims to discuss the historical and genealogical constitution of AA, highlighting its subjective effects around the category alcoholism. We conducted a bibliographic study using the written production of AA, analyzing the data from the Foucaultian perspective. We found that AA individualized the diagnosis of alcoholism, which was previously conceived as a social disease. We conclude that AA reformulated the conception of alcoholic disease giving it a subjective connotation and inaugurated a pragmatic therapy whose effect was a new identity construction based on a moral of life

El surgimiento del alcoholismo como categoría médica alfinal del siglo XIX fue contemporáneo a las intervenciones médicas en las masas populares urbanas. Mas adelante, los Alcohólicos Anónimos (AA) surgen como una hermandad con el propósito de tratar la 'enfermedad alcohólica' partiendo de preceptos metódicos y espiritualistas. Este artículo tiene como objetivo discutir la constitución histórica y genealógica de los AA, destacando sus efectos subjetivos en torno de la categoría alcoholismo. Emprendemos un estudio bibliográfico utilizando la producción escrita de los AA, analizando los dados a partir de la perspectiva de Foucault. Constatamos que los AA individualizaron el diagnóstico de alcoholismo, hasta entonces considerado como una enfermedad social. Concluimos que los AA reformularon la concepción de enfermedad alcohólica dándole una connotación subjetiva y inauguraron una terapéutica pragmática cuyo efecto fue una nueva construcción de identidad fundamentado en una moral de vida

Factores Asociados al No Consumo de Alcohol en Personas Dependientes en Recuperación / Factors Associated with Not Drinking Alcoholic Beverages in Dependent Individuals on Recovery / Fatores Associados ao Não Consumo de Álcool em Pessoas Dependentes em Recuperação

Objective. This work sought to determine the association between personal factors and not drinking alcoholic beverages in alcohol-dependent individuals on recovery process. Methods. This was a cross-sectional quantitative study. The sample was comprised by 119 adult belonging to 50 Alcoholics Anonymous groups in Saltillo, Coahuila (Mexico). The sampling was simple random, by conglomerates (AA groups). To gather the information, a Personal Data Card was used along with a history on alcohol consumption and the instruments Scale on Social Readjustment Classification, Spiritual Perspective Scale, Schwartz Values Survey, and the Alcohol Use Disorders Identification Test (AUDIT). Results. The time without alcohol consumption was related positively with age (r=0.59) and spirituality (r=0.29) and negatively with stressful events (r=-0.31). The Multiple Linear Regression Model explained 32.5% of the variance, with age being the variable remaining in the model and which affected not drinking alcoholic beverages. Conclusion. Values and spirituality favor not drinking alcoholic beverages in individuals in the process of recovering from the dependence, while exposure to stressful events increases vulnerability to alcohol consumption. (AU)

Objetivo. Determinar la asociación entre los factores personales y el no consumo de alcohol en personas dependientes en proceso de recuperación. Métodos. Estudio cuantitativo, de corte transversal. La población estuvo conformada por 119 adultos pertenecientes a los 50 grupos de Alcohólicos Anónimos de Saltillo, Coahuila (México). El muestreo fue aleatorio simple, por conglomerados (grupos AA). Para la recolección de la información se utilizó una Cédula de Datos Personales e Historial de Consumo de Alcohol y los instrumentos Escala de Clasificación de Reajuste Social, Escala de Perspectiva Espiritual, Cuestionario de Valores Schwarts y Cuestionario de Identificación de los Trastornos debidos al Consumo Alcohol (AUDIT). Resultados. El tiempo sin consumo de alcohol se relacionó en forma positiva con la edad (r=0.59) y con la espiritualidad (r=0.29) y en forma negativa con los eventos estresantes (r=-0.31). El Modelo de Regresión Lineal Múltiple explicó el 32.5% de la varianza, siendo la edad la variable que se mantuvo en el modelo y tuvo efecto sobre el no consumo de alcohol. Conclusión. Los valores y la espiritualidad favorecen el no consumo de alcohol en las personas en proceso de recuperación de su dependencia, mientras que la exposición a eventos estresantes aumenta la vulnerabilidad al consumo. (AU)

Objetivo. Determinar a associação entre os fatores pessoais e o não consumo de álcool em pessoas dependentes de álcool em processo de recuperação. Métodos. Estudo quantitativo, de corte transversal. A amostra esteve conformada por 119 adultos pertencentes aos 50 grupos de Alcoólicos Anônimos de Saltillo, Coahuila (México). A amostragem foi aleatória simples, por conglomerados (grupos AA). Para a recolecção da informação se utilizou uma Cédula de Dados Pessoais e Historial de Consumo de Álcool e os instrumentos Escala de Classificação de Reajuste Social, Escala de Perspectiva Espiritual, Questionário de Valores Schwarts e Questionário de Identificação dos Transtornos devidos ao Consumo Álcool (AUDIT). Resultados. O tempo sem consumo de álcool se relacionou em forma positiva com a idade (r=0.59) e com a espiritualidade (r=0.29) e em forma negativa com os eventos estressantes (r=-0.31). O Modelo de Regressão Lineal Múltiplo explicou 32.5% da variação, sendo a idade a variável que se manteve no modelo e teve efeito sobre o não consumo de álcool. Conclusão. Os valores e a espiritualidade favorecem o não consumo de álcool nas pessoas em processo de recuperação da dependência, enquanto que a exposição a eventos estressantes aumenta a vulnerabilidade ao consumo. (AU)

Alcoólicos anônimos e a recaída: análise à luz da experiência elementar / Alcoholics anonymous and relapse: analysis in the light of the elemental experience / Alcohólicos anónimos y la recaída: análisis a la luz de la experiencia elemental

A recaída é considerada, em alguns estudos, como um processo que compreende tanto o retorno ao consumo da substância química como os momentos anteriores que advertem sobre o risco de o abstêmio recidivar. O programa dos Alcoólicos Anônimos (AA) visa à sobriedade pela abstinência total do álcool. O objetivo da pesquisa foi analisar a expressão da experiência elementar no processo de recaída vivenciado por membro de AA, com base na elaboração da experiência dos sujeitos. Trata-se de pesquisa qualitativa, cuja coleta de dados deu-se mediante entrevistas semiestruturadas, das quais participaram cinco membros de AA de três grupos de Montes Claros-MG. Empregou-se a análise fenomenológica para o tratamento dos dados, via que possibilitou a apreensão de quatro categorias temáticas: pertencimento; posicionamento pessoal; exigência de ser; e experiência religiosa. A dinâmica da experiência elementar do alcoolista, expressa no processo de recaída, orienta o posicionamento deste diante de si e do mundo.

Relapse is considered in some studies as a process which comprises both the return to the use of a chemical substance as well as the previous moments warning about the danger of an abstemious person to relapse. The Alcoholics Anonymous Program (AA) aims to reach sobriety based on total alcohol abstinence. The objective of the research was to analyze the expression of elemental experience in the process of relapse experienced by AA members, through the elaboration of the subjects’ experiences. It turns out to be a qualitative research, where the data collection procedure occurred through semi-structured interviews. The interviewees were five members from three AA groups in the city of Montes Claros-MG. We applied the phenomenological analysis to process the data, which allowed us to establish four thematic categories: belonging; personal positioning; requirement for being; and religious experience. The dynamics of the alcoholics’ elementary experience, expressed in the relapse process is the guide to their attitudes towards themselves and the world.

La recaída es considerada en algunos estudios como un proceso que incluye tanto el hecho de volver a consumir sustancias químicas, como los momentos anteriores que advierten del riesgo de que el abstemio reincida. El programa de Alcohólicos Anónimos (AA) tiene como objetivo la sobriedad a través de abstinencia total de alcohol. El objetivo de la investigación fue analizar la expresión de la experiencia elemental en el proceso de recaída experimentada por miembros de AA con base en la elaboración de la experiencia de los sujetos. Se trata de una investigación cualitativa, cuya recolección de datos se dio a través de entrevistas semiestructuradas, en las cuales participaron cinco miembros de AA de tres grupos de Montes Claros-MG. Se aplicó el análisis fenomenológico para tratamiento de datos, lo que permitió captar cuatro categorías temáticas: pertenecimiento; posicionamiento personal; exigencia de ser; y experiencia religiosa. La dinámica de la experiencia elemental del alcohólico, expresada en el proceso de recaída, indica su posicionamiento ante sí mismo y el mundo.

Community experience and personal accomplishment in Alcoholics Anonimous: a phenomenological research / Experiência comunitária e realização pessoal em Alcoólicos Anônimos: uma pesquisa fenomenológica / Experiencia comunitária y autorrealización en Alcohólicos Anónimos: un estudio fenomenológico

We aim to understand how the subjects achieve themselves in Alcoholics Anonimous (A.A.) live community experience in the context and how this experience connects to personal formation and accomplishment. We carry out interviews with four participants of A.A., whose data were analyzed phenomenologically. We learned that the encounter with the other enables reassurance of the life and the alcoholic condition, personal growth and accomplishment; the communitarian companionship is marked by solidarity and friendship relationship, building the context of the A.A., wich supports the recovery process. We conclude that the personal accomplishment, the achievement and maintenance of sobriety are favored by personal training of community ties in the A.A. and by line between formal principles and personal values.

Objetivamos compreender como os sujeitos que se autorrealizam em Alcoólicos Anônimos (A.A.) vivenciam a experiência comunitária nesse contexto e como essa experiência se associa à realização e formação pessoal. Realizamos entrevistas com quatro participantes de A.A., cujos dados foram analisados fenomenologicamente. Apreendemos que o encontro com o outro possibilita a ressignificação da vida e da condição de alcoolista, crescimento pessoal e autorrealização; a convivência comunitária é marcada por relações de amizade, solidariedade, construção do contexto de A.A. que é sustento para o processo de recuperação. Concluímos que a realização pessoal, a conquista e a manutenção da sobriedade são favorecidas pela formação pessoal de vínculos comunitários em A.A. e pela sintonia entre princípios formais e valores pessoais.

Nuestro objetivo es entender cómo los sujetos que experimentam autorrealización en Alcohólicos Anónimos (A.A.) experimentam la experiencia comunitaria en este contexto y la forma en que la experiencia se asocia con el autorrealización y la formación personal. Hemos llevado a cabo entrevistas con cuatro participantes de A.A. cuyos datos fueron analizados fenomenológicamente. Aprehendemos que el encuentro con el otro permite el replanteamiento de la vida y la condición de los alcohólicos, el crecimiento personal y la autorrealización; la relación comunitaria está marcada por las relaciones de amistad, la solidaridad, la construcción del contexto de A.A. que es mantener para el proceso de recuperación. Llegamos a la conclusión de que a autorrealización, el logro y el mantenimiento de la sobriedad son favorecidos por la formación personal de los lazos comunitarios en A.A. y la línea entre los principios formales y los valores personales.

Teoría de situación específica de autotrascendencia en dependientes del alcohol en proceso de recuperación / Theory of the Specific Situation of Self-transcendence in Persons Recovering from Alcohol Dependence / Teoria de situação específica de autotranscendência em dependentes do álcool em processo de recuperação

La creación de modelos y teorías de enfermería, enfocadas en fenómenos específicos, contribuye a la práctica y el desarrollo de la disciplina de enfermería. Objetivo: presentar una derivación teórica y proponer un modelo sobre la teoría de autotrascendencia en personas dependientes del alcohol en proceso de recuperación. Materiales y métodos: se realizó una derivación teórica mediante la metodología propuesta por Walker y Avant. Resultados: adaptación del Modelo de Autotrascendencia en personas dependientes del alcohol en proceso de recuperación en Alcohólicos Anónimos. Conclusiones: el modelo puede ser útil para explicar cómo las personas dependientes del alcohol, que se encuentran en tratamiento, logran el bienestar y cuáles son los factores que influyen durante el proceso.

The creation of nursing models and theories focused on specific phenomena contributes to the practice and development of the discipline of nursing. Objective: The purpose of this study is to present a theoretical derivation and propose a model on the theory of self-transcendence in persons recovering from alcohol dependence. Materials and methods: A theoretical derivation was done using the method proposed by Walker and Avant. Results: Adaption of the self-transcendence model in alcohol-dependent persons who are involved in a recovery process as part of Alcoholics Anonymous. Conclusions: The model can be useful in explaining how alcohol dependent persons, who are in treatment, achieve well-being and what are the influencing factors during the process.

A criação de modelos e teorias de enfermagem enfocados em fenómenos específicos contribui para a prática e desenvolvimento da disciplina de enfermagem. Objetivo: apresentar uma derivação teórica e propor um modelo sobre a Teoria de Autotranscendência em pessoas dependentes do álcool em processo de recuperação. Materiais e métodos: realizou-se uma derivação teórica mediante a metodologia proposta por Walker e Avant. Resultados: adaptação do Modelo de Autotranscendência em pessoas dependentes do álcool em processo de recuperação em Alcóolicos Anônimos. Conclusões: o modelo pode ser útil para explicar como as pessoas dependentes do álcool, que se encontram em tratamento, atingem o bem-estar e quais são os fatores que influenciam durante o processo.

Análisis de la aproximación de Alcohólicos Anónimos a los pacientes hospitalizados / Analysis of Alcoholics Anonymous' approach to hospitalized patients

Antecedentes: El porcentaje de dependientes alcohólicos que acude a los grupos de autoayuda aumentó del 33.4% en 2008 al 43.7% en 2011 según las Encuestas Nacionales de Adicciones. Alcohólicos Anónimos (AA) y su programa de Doce Pasos representa el principal modelo de autoayuda en México. El 12° Paso o llevar el mensaje es una estrategia común para atraer nuevos miembros a los grupos de AA y se realiza frecuentemente en salas hospitalarias.Objetivo: Describir la actividad de llevar el mensaje en un contexto hospitalario para identificar los significados implicados y la manera de relacionarse con los pacientes.Método: Se utilizó una aproximación etnográfica para observar la actividad de nueve miembros de AA en un hospital de tercer nivel de la Ciudad de México a lo largo de diez meses. Se aplicó el modelo del sistema de actividad para la organización e interpretación de los datos.Resultados: La actividad de llevar el mensaje tiene seis momentos principales: 1. Autopresentación del alcohólico en recuperación; 2. Definición del alcoholismo como una enfermedad sin cura; 3. Los Doce Pasos de AA como una alternativa; 4. Autodiagnóstico; 5. Preguntar sobre el consumo; 6. Invitación a las juntas del grupo de AA en el hospital. Los miembros de AA utilizan sus relatos personales para comunicar la visión de AA sobre el alcoholismo y la recuperación.Discusión y conclusión:Llevar el mensaje se orienta principalmente por el significado de la negación del alcoholismo. Las acciones de los AA están diseñadas para evitar la negación y promover la aceptación de la enfermedad. Además, el mismo contexto hospitalario legitima la presencia de AA y sus Doce Pasos. Llevar el mensaje nos presenta una estrategia para disminuir el estigma asociado con la dependencia alcohólica, el cual es uno de los principales obstáculos para solicitar ayuda.

Background: The percentage of alcohol dependents who attend self-help groups increased from 33.4% in 2008 to 43.7% in 2011 according to the National Surveys of Addictions. Alcoholics Anonymous (AA) and their Twelve Steps program represent the main model for self-help in Mexico. The 12th Step or carrying the message is a common strategy to attract new members into AA groups and it is done frequently at hospital wards.Objective: To describe the activity of carrying the message in a hospital context in order to identify the meanings involved and how AA members relate to the patients.Method: An ethnographic approach was used to observe the activity of nine AA's members in a third level hospital in Mexico City over a ten-month period. The activity system model was used for data organization and interpretation.Results: The carrying the message activity consists of six core moments: 1. Self-introduction of the recovering alcoholic; 2. Defining alcoholism as an incurable disease; 3. AA's Twelve Steps as an alternative; 4. Self-diagnosis; 5. Ask about consumption; 6. Invitation to hospital AA's group meetings. The AA's member uses personal experience's stories to convey AA vision about alcoholism and recovering.Discussion and conclusion: The carrying the message activity is mainly oriented by the meaning of alcoholism-denial. The AA's actions are designed to avoid denial and to promote disease acceptance. Furthermore, the hospital setting itself legitimizes the AA presence and their Twelve Steps. Carrying the message presents a strategy to diminish stigma related to alcohol dependency which is one of the main obstacles for seeking help.

Estilos de afrontamiento a la "obsesión mental por beber" (craving) en bebedores en proceso de recuperación / Coping styles to "obsession for drinking" (craving) for alcoholics in recovery process

Antecedentes: En el alcoholismo, el tema del craving es un asunto controvertido. Sin embargo, se sabe que, si un alcohólico puede hablar del suceso en sus propios términos, aumenta la probabilidad de lograr un afrontamiento exitoso y evitar una recaída. No obstante, se conoce muy poco acerca de dicho afrontamiento y aún menos cuando se alude a él con términos propios del bebedor.Objetivo: Conocer el afrontamiento de la "obsesión mental por beber", expresión que suelen utilizar los miembros de Alcohólicos Anónimos (AA) para hablar de las reacciones características del craving.Método: La muestra incluyó a 192 individuos que habían participado en AA durante 10 años en promedio (DE=7.5 años). Se aplicó un instrumento empírico para medir el afrontamiento (Kr=.86). Se utilizó un conglomerado de dos fases para establecer perfiles.Resultados: El análisis encontró cinco estilos de afrontamiento: 1. evadir situaciones inductoras al tiempo que se busca una solución (evasivo-activo); 2. evadir retrayéndose (evasivo-pasivo); 3. mostrar sentimientos de enojo y no hacer nada (emocional-pasivo); 4. recordar y comparar la vida pasada como alcohólicos activos (revalorativo) y 5. negar cualquier afrontamiento (negador).Discusión y conclusion: Los datos son preliminares, pero ofrecen la oportunidad de ampliar y especificar la forma en que ciertos alcohólicos de nuestro país solucionan un problema tan complejo como es el craving. El agrupamiento de respuestas supone esfuerzos o estilos de afrontar que pueden resultar o no efectivos para lograr una recuperación -por ejemplo, prevenir las recaídas en las personas que asisten a los grupos de AA-, por lo que plantea una importante perspectiva de investigación.

Background: Although craving is a controversial concept in alcoholism research, it is known that if an alcoholic can talk about the event using his own words, the probability of successful coping and prevention of relapse is bigger. However, little is known about such coping, and even less when it is articulated from the drinker's perspective.Objective: To identify the coping mechanism to this event that causes physical and emotional responses similar to those of craving, identified with the own language of Alcoholics Anonymous (AA).Method: The sample consisted of 192 individuals who participated in AA meetings for an average of ten years (SD=7.5). An empirical instrument was developed to measure coping (Kr=.86) and a two-phase conglomerate analysis was used to create categories to develop profiles.Results: The analysis showed five coping profiles suggesting that AA members cope with the event as follow: 1. evading but looking for a direct solution (elusive-active conglomerate), 2. evading but retracting (elusive-liabilities conglomerate), 3. getting upset and doing nothing (emotional-passive conglomerate), 4. remembering and comparing their past life (revalorative conglomerate), and 5. denying (denier conglomerate).Discussion and conclusion: Although the data are preliminary, they offer the opportunity to expand and specify how certain alcoholics solve a complex problem, such as craving. The information concurs with literature in the sense that this grouping of responses assumed those efforts that may be effective or not for the recovery process, for example, to prevent relapses in alcoholics who attend AA groups, so it raises an important research perspective.

A proposed mechanism of action for the Twelve steps of Alcoholics Anonymous / Un mecanismo de acción propuesto para los Doce pasos de Alcohólicos Anónimos

Entre los grupos de apoyo mutuo a alcohólicos, Alcohólicos Anónimos (AA) es, sin duda, el más exitoso de todos, con decenas de miles de grupos dispersos por el mundo. Sin embargo, el mecanismo de acción de AA no está claro. Los avances en la neurociencia de la adicción han permitido identificar dos áreas cerebrales que, entre otras, explican el comportamiento irracional y autodestructivo de los alcohólicos. Por un lado, el alcohol “secuestra” los centros del cerebro encargados de detectar y sentir placer, y le proveen (a través de la liberación de dopamina en el núcleo accumbens y el área ventro-tegmental) con un estímulo placentero mucho mayor al de las experiencias típicas que nos producen placer (tales como alimentarnos y reproducirnos), siendo experiencias esenciales para la supervivencia y la evolución de las especies. La reproducción y evolución de las especies solo es posible por la forma en que el placer está íntimamente ligado a la sobrevivencia y reproducción del individuo, y es esta asociación la que es usurpada por las sustancias como el alcohol. Por lo tanto, para los centros del placer el alcohol equivale a la supervivencia del alcohólico. Por otro lado, el área de la corteza prefrontal (quizás el único lugar del cerebro que nos permite entender y prevenir los peligros del uso excesivo y compulsivo del alcohol) es también afectada por esta sustancia, que la convierte en hipoactiva e incapaz de contrarrestar las demandas del centro del placer de repetir la experiencia placentera (que ha resultado en la supervivencia del individuo y la evolución de las especies) asociada a usar alcohol. Los doce pasos de AA ayudan al alcohólico a revertir estos efectos, a través del uso de un sustituto en la toma de decisiones (el sustituto es, con frecuencia, los miembros de AA) y a través de conductas compensatorias dedicadas a revertir las conductas destructivas que facilitan al alcohólico el poder continuar intoxicándose. El mentir, robar, no ser honesto y ser manipulador no son síntomas de un trastorno de personalidad del alcohólico: son los síntomas de un centro del placer secuestrado por el alcohol y de una corteza prefrontal hipoactiva.

Among peer-support groups for alcoholics, Alcoholics anonymous (AA) is by far the most widespread and successful with tens of thousands of groups all around the world. However, the mechanism of action of AA’s success is not immediately clear. Advances in understanding the neuroscience of addiction have allowed the identification of two brain areas that, among others, explain the irrational and self-destructive behavior of alcoholics. First, alcohol hijacks the reward systems of the midbrain in charge of detecting and experiencing pleasure (through the release of dopamine in the nucleus accumbens and the ventral tegmental area) with a pleasurable stimulation that far exceeds the normal pleasures of life (such as eating and sexual reproduction). These pleasurable experiences are essential for the survival and evolution of the species. Nature has cleverly linked pleasure with survival, and it is exactly this link that is usurped and hijacked by intoxicants like alcohol. Therefore, the reward system senses the effect of alcohol as essential for the survival of the alcoholic. In addition, the prefrontal cortex (perhaps the only area of the brain that could allow us to understand and prevent the dangers of the excessive and compulsive alcohol use) is also affected by this intoxicant. It becomes hypoactive and unable to counteract the urges and demands of the reward system to constantly repeat the “feel good” (associated over millions of years with survival of the individual and species) that comes from using alcohol. The Twelve Steps of AA help alcoholics reverse these effects. First, through steps 1 to 3, it encourages the use of a Surrogate Decision-Maker (often, it is the AA group itself that acts as such). Second, steps 4- 12 foster the practice of Compensatory Behaviors (a life of honesty and service) devoted to counteract the maladaptive behaviors that facilitate the alcoholic’s behavior of repeating what feels good (i.e. getting intoxicated). Lying, stealing, dishonesty and manipulation are not intrinsic personality defects of the alcoholic: they are the symptoms of a usurped reward system and hijacked prefrontal lobes.

Grupo de autoajuda como modalidade de tratamento para pessoas com dependência de álcool / Self-help groups as a modality of treatment for alchool dependence / Grupo alcohólicos anónimos como tratamiento para las personas con dependencia del alcohol

Grupos de autoajuda estão se tornando cada vez mais comuns, à medida que seus membros se organizam para conviver com o alcoolismo e resolver seus próprios problemas. Objetivou-se apreender da vivência de alcoolistas o modo como um grupo de autoajuda se constitui como modalidade de tratamento para pessoas com dependência de álcool. Estudo descritivo, qualitativo, realizado com 20 membros de um grupo de autoajuda. Os dados foram produzidos mediante entrevista semiestruturada e analisados conforme o método de análise de conteúdo. Resultados denotam que acolhimento, partilha de experiências e reinserção social, favorecem a participação no grupo e que, consequentemente, contribuem para o bem-estar físico, mental e social. Ressalta-se a necessidade de parcerias com grupos de autoajuda, tendo em vista a importância de conhecimentos produzidos nestas organizações, que podem ser colocados em favor daqueles que precisam do devido cuidado.

Self-help groups are becoming increasingly common as their members become organized in order to live and solve their own alcohol-related problems. This study aimed to identify, based on the experience of alcoholics, how a self-help group constitutes itself as a treatment alternative for alcohol dependence. A descriptive, qualitative study was conducted with 20 members of a self-help group. Data were collected through semi-structured interviews and analyzed according to the content analysis technique. Results show that supportive reception, exchange of experiences, and social reintegration favors participation in the group and, consequently, contributes to physical, mental and social wellbeing. There is a need to establish partnerships with self-help groups considering the importance of knowledge produced within these organizations, which can assist those requiring appropriate care.

Grupos de autoayuda se están convirtiendo cada vez más comunes, a medida que sus miembros se organizan con el fin de vivir y resolver sus propios problemas relacionados con el alcohol. Este estudio tuvo como objetivo aprender de la experiencia de manejo con los alcohólicos como un grupo de autoayuda se desarrolla como tratamiento para las personas con dependencia del alcohol. Estudio descriptivo, cualitativo con 20 miembros de un grupo de autoayuda. Los datos fueron recolectados a través de una entrevista semi-estructurada y analizados según el método de análisis de contenido. Los resultados muestran que la acogida del intercambio de experiencias y la reintegración social, promueven la participación en el grupo y contribuyen al bienestar físico, mental y social. Se hace hincapié en la necesidad de crear alianzas con grupos de auto-ayuda, en vista de la dependencia de los conocimientos producidos en estas organizaciones, que se puede colocar en la necesidad daquelesque a favor de la diligencia debida.

Repercusión social y análisis bioético del alcoholismo en pacientes del Grupo de Alcohólicos Anónimos de La Habana / Social repercussion and bioethical analysis in patients from the Anonymous Alcoholic Group

OBJETIVO: Valorar desde un punto de vista bioético, la repercusión social que ha tenido la ingestión de bebidas alcohólicas en las personas que pertenecen a Alcohólicos Anónimos. MÉTODOS: El estudio realizado fue observacional, descriptivo, longitudinal y prospectivo. Se realizó una solicitud de consentimiento informado. Las técnicas de investigación que se usaron fueron cualitativas y cuantitativas. Se utilizó como instrumento un cuestionario elaborado por los autores y validados por psicólogos que nos permitió realizar una valoración bioética. La población estuvo constituida por 200 pacientes pertenecientes al Grupo de Alcohólicos Anónimos de la provincia Ciudad de La Habana, de ellos 50 fueron atendidos en el hospital Julio Trigo López con la coordinación y cooperación de su sede, localizada en el Vedado. Las encuestas se aplicaron entre enero y diciembre de 2007. RESULTADOS: El 100 por ciento de los pacientes consideran que su forma de beber está creando dificultades en su salud, en su familia, en sus relaciones con los vecinos y en su trabajo, el 98 por ciento tiene dificultades para controlarse cuando bebe. El tiempo transcurrido en aparecer las complicaciones en el 73,5 por ciento fue de meses, en el 17 por ciento de años y en el 9,5 por ciento de días. El 94 por ciento considera que el alcoholismo es una enfermedad. El 89,5 por ciento de los pacientes atendidos en los diferentes niveles de salud se han sentido bien tratados. La totalidad de las personas encuestadas consideran que son discriminadas por la sociedad. CONCLUSIONES: Los principios bioéticos son violados de forma variable en un grupo de pacientes alcohólicos. Alcohólicos Anónimos representa para los pacientes afectados de alcoholismo, una organización que les brinda apoyo, les da esperanza y los ayuda a mantenerse en abstinencia

OBJECTIVE: To assess from the bioethical point of view the social repercussion having the ingestion of alcohol in the persons belonging to Anonymous Alcoholics. METHODS: An observational, descriptive, longitudinal and prospective study was conducted. Informed consent was requested. The researches techniques used were of qualitative and quantitative types, as instrument it was used a questionnaire designed by authors and validated by psychologists allowed us to perform the bioethical assessment. Universe included 200 patients belong to Anonymous Alcoholic Group from Ciudad de La Habana province, 50 of them were care in the Julio Trigo López: Hospital with the coordination and the cooperation of its seat, located in the Vedado , Plaza Municipality. Surveys were administered between January and December, 2007. RESULTS: The 100 percent of patients consider that its way of drink is provoking difficulty with its health, its family, its neighbor's relationships and in its job; the 98 percent have difficulties to control itself when drink. The time elapsed from the appearance of complications is of 73.5 percent months, in the 17 percent of years and in the 9.5 percent of days. The 94 percent considers that alcoholism is a disease. The 89.5 percent of patients seen in the different health levels consider that they have been well treated. Total of the persons polled think that they are discriminated by society. CONCLUSIONS: The bioethical principles are infringed in a variable way in a group of alcoholic patients. Anonymous Alcoholics represent for patients involved of alcoholism an organization offering them support, hope and help them to maintain in abstinence

Alcohólicos Anónimos (AA): aspectos relacionados con la adherencia (afiliación) y diferencias entre recaídos y no recaídos / Alcoholics Anomymous (AA): affiliation and related aspects, differences between relapsed and non-relapsed alcoholics in process of recovery

The work of Alcoholics Anonymous (AA) in fighting against alcohol abuse and alcoholism has placed it as an institution of great importance in Mexico and around the world. Although its labor has been subject for controversy, there is a lot of evidence that frequent attendance and affiliation to the groups and sessions can be very helpful for many individuals. Research has been dedicated to the identification of the elements contributing to affiliation, such as involvement, commitment, and participation, or the level of adherence to the program's beliefs and activities. Some studies have used the time of membership and the frequency of attendance to AA as indicators of affiliation, but there are some authors who think that it is difficult to explore it using only these variables. Other authors have mentioned that alcoholics can go to AA for many reasons, but that mere attendance is not enough for reaching or maintaining abstinence. It has been established that when the impact of AA is measured only by the time of membership or the frequency of attendance, it is not possible to comprehend the essence of the subjective and behavioral characteristics involved in the process. Thus, it is important to differentiate between these and the true affiliation. There are only a few researches about the elements forming the affiliation to AA, and the ones available do not bring light over the process of its beginning. Some authors say that it is something more than the time or the frequency of attendance to meetings, and that is possible that it is a complex and heterogeneous phenomenon formed by several behaviors and beliefs about the 12 steps. Some studies have pointed out the interaction of different factors to achieve affiliation, but they have also remarked the need for including more variables in measuring it. One conclusion is that affiliation is a whole dimension that encompasses attendance and the level of participation in the activities. There are different questionnaires to measure the affiliation process, but most of them are difficult to interpret, and little is known about their fitting to AA members' perspective of things. Research in Mexico is complicated because of a lack of instruments developed from the local situation and experience. There are data that about 14 000 alcoholics enter AA every year. Relapse is high during the first three months (near 50%), but almost half of the persons that stay show adherence to the program, and eventually reach abstinence. Yet, the topic of the specific elements of affiliation, as well as their influence to maintain abstinence, has not received enough attention. The objectives of this study were: 1. to analyze the elements that constitute an affiliation profile, 2. to know if such elements are different or if they are part of a single construct, and 3. to find out if the amount of affiliation (the way an alcoholic involves him/herself in the activities of the group) can distinguish between those who have relapsed and those who have not. Method The sample was non-probabilistic; it included 192 AA members (87% men and 13% women). Average age was 42 years old. Two groups were formed: relapsed and non-relapsed (143 who did not consume any amount of alcohol since they entered AA or 10 years or more ago, and 49 who consumed any amount of alcohol within the four years prior to the interview). The questionnaire included scales to measure the service, the practice of the 12 steps, the spiritual awakening, sponsoring, time spent in AA, frequency of attendance, and reading of the materials. The questionnaire was specifically designed for measuring affiliation. Results There were significative differences in the mean participation time (it was higher in the non-relapsed subjects: t = -3.225, df=181, p<.00), in the activities related to <> (they were more frequent and more extended in time in the non-relapsed subjects: X² = 7.76, p< .01; t = -2.258, df= 145, p< .02), in <> (most of the non-relapsed subjects are one: X² = 15.06, p< .000), in the practice of the steps 3-12 (non-relapsed AA practiced them more: X² = 5.16, p<.02), and in having the spiritual awakening experience (more frequent in the non-relapsed subjects: X² = 4.282, p<. 05). Internal consistency tests were executed, as well as a factor analysis to explore if the items that differentiated between the groups could form a single dimension. The first analysis resulted in a satisfactory internal consistency (cc = .67). The items were grouped in a unique dimension with an explained variance of 43.6%. An indicator for affiliation was developed through the sum of the scores from variables grouped in the factor analysis. A comparison using this indicator showed significant differences in the degree of involvement in AA (Z = -3.367, p<.001). Non-relapsed subjects had an affiliation ranging from high to very high. Discussion Results suggest that affiliation is an event formed by several elements that, either separated or combined, can behave significantly different between relapsed and non-relapsed AA members. This could mean that such variables are adherence or affiliation indicators. These elements are not exclusive or unrelated entities, but they constitute a measure of affiliation to AA. Its structure leads to consider them as part of the same phenomenon which could help to determine more precisely the degree of affiliation; the categorization made evident that there is an important association with abstinence. Thus, affiliation scores varied importantly between groups; the highest ones were on those who have maintained abstinence. It is possible to deduct that alcoholic subjects who participate more actively and during more time in AA get more positive results. These results concur with others in the sense that reaching long periods of abstinence in AA is related to a greater involvement in the activities of the groups. Likewise, the frequency of attendance to the meetings did not differentiate between relapsed and non-relapsed; this could suggest that just being there is not enough to obtain a satisfactory result. AA literature points out to the fact that attendance is a necessary condition for recovering, but its benefits reduce considerably without a genuine desire of involvement. The performance of the affiliation indicators identified in this study suggests the possibility of considering them as a dimension that explain the amount in which it exists in AA members. The fact that such dimension emerged from the experience of members from national groups represents an opportunity to use it as a valid scale in broader researches with bigger samples, and a chance to find out in a more reliable way the real role of AA in the recovery process. Since AA represents one of the most popular choices for the treatment of alcoholism in Mexico, research should continue for broadening the knowledge that health professionals, researchers, and everyone involved in prevention have about this organization. As shown by the results of this study, a better understanding of the benefits produced by the active participation in AA could help to motivate not only attendance to the meetings, but a full involvement in the activities suggested by the groups. The final effects may result in a reduction of the health costs generated by alcoholism and related problems attention.

La labor realizada por los grupos de Alcohólicos Anónimos (AA) para combatir el problema del alcoholismo los ha convertido en una de las opciones importantes. La adherencia o afiliación a estos grupos puede ser benéfica para ciertos alcohólicos, por lo que la investigación ha buscado identificar los aspectos que contribuyen a su establecimiento. Aunque la investigación aún no aclara el proceso mediante el que se logra, la ha destacado como un constructo que entrelaza la asistencia a las reuniones y el nivel de participación en los grupos, y se menciona que, cuanto mayor es el involucramiento, tiende a mejorar el pronóstico del alcohólico. A pesar de este panorama, en nuestro contexto, el tema de los componentes específicos de la afiliación a AA, así como su relevancia para mantener la abstinencia en comparación con la recaída, no ha recibido atención suficiente por parte de los investigadores en alcoholismo. Este trabajo tiene como objetivos: explorar elementos que pueden constituir un perfil de afiliación a AA, conocer si esos elementos son diferentes o forman parte de un mismo constructo y si la graduación de afiliación (clasificación de la forma en que el alcohólico se involucra en las diferentes actividades de los grupos) puede diferenciar entre quienes han recaído o no en el consumo de alcohol. Método La muestra fue no probabilística intencional; incluyó a 192 miembros de AA (87% hombres y 1 3% mujeres). Se formaron dos grupos: no recaídos y recaídos (143 no consumieron ninguna cantidad de alcohol y 49 consumieron cualquier cantidad de alcohol después de por lo menos tres meses de abstinencia). Se diseñó un cuestionario para evaluar la afiliación a AA; en éste se indaga el servicio, el apadrinamiento, la práctica de los 12 pasos, el <>, el tiempo en AA, la frecuencia de asistencia y la lectura de literatura de AA. Resultados Hubo diferencias significativas en el tiempo promedio de participación (t = -3.225, gl = 181, p<.00), en la actividad de <> (tenerlo: χ² = 7.76, p<.01 y horas dedicadas: t = -2.258, gl = 145, p<.02), tener la función de <> ( χ²=15.06, p< .000), en la práctica reciente de los pasos 3 al 12 ( χ² = 5.166, p<.02) y en la experiencia del <> ( χ² = 4.282, p<. 05), todos mayores en los no recaídos. Tras eliminar <>, se encontró una consistencia interna adecuada (α =.67) y un análisis factorial mostró que los reactivos se agrupaban en una sola dimensión, con una varianza explicada de 43.6%. Se construyó un indicador del grado de afiliación usando la sumatoria de los puntajes de las variables agrupadas y se trabajó una comparación por quintiles, la cual mostró diferencias significativas según el grado de involucramiento en AA (Z = -3.367, p<.001). Los no recaídos mostraron una afiliación que va de alta a muy alta. Discusión En este estudio, la afiliación a AA parecería un suceso compuesto por distintos elementos que se comportaron de modo significativamente diferente entre los recaídos y no recaídos. No fueron entidades separadas, sino partes de un mismo constructo que, trabajado en forma de quintiles (muy baja, baja, moderada, alta y muy alta), evidenció una asociación importante con la abstinencia. Los índices variaron de manera significativa entre los grupos de recaídos y no recaídos; los mayores se vieron en quienes han mantenido la abstinencia por largos periodos. Este resultado confirma hallazgos de estudios anteriores, en el sentido de que los alcohólicos más participativos en AA obtienen resultados más favorables. Los indicadores de afiliación detallados sugieren la posibilidad de considerarlos como una dimensión que dé cuenta del grado en que se manifiesta en los miembros de AA. Además, el que emergiera de la experiencia de los miembros de grupos nacionales representa la oportunidad de estructurarla como una escala válida para futuras investigaciones con muestras más grandes e indagar con mayor confiabilidad sobre el papel que desempeña AA en el proceso de recuperación del alcoholismo.

Porque os alcoólicos são anônimos? Anonimato e identidade no tratamento do alcoolismo / Why are alcoholics anonymous? Anonymity and identity in treating alcoholism / ¿Por qué los alcohólicos son anónimos? Anonimato e identidad en el tratamiento del alcoholismo

Pretende-se contribuir para a compreensão do papel do anonimato no modelo terapêutico desenvolvido pela irmandade de Alcoólicos Anônimos (A.A.) para dar conta da "doença do alcoolismo". Realizou-se uma pesquisa bibliográfica na literatura produzida pela irmandade sobre o álcool e o alcoolismo, bem como uma pesquisa qualitativa em grupos de A.A. localizados na periferia da cidade de São Paulo - Brasil -, com realização de entrevistas e a observação de diversas atividades promovidas pelos seus membros. O modelo terapêutico de A.A. é concebido como um sistema cuja realidade simbólica é fundamental na representação do alcoolismo como uma "doença crônica e fatal" e, consequentemente, na construção da identidade de "doente alcoólico". Com efeito, o anonimato opera como um mecanismo simbólico fundamental no processo saúde-doença vivenciado dentro de A.A., ligando-se diretamente à fabricação da identidade do "doente alcoólico em recuperação" e, por essa via, à reconstrução subjetiva dos membros da irmandade.

The aim here was to contribute towards understanding the role of anonymity in the therapeutic model developed by the Alcoholics Anonymous (AA) fellowship for caring for the "disease of alcoholism". A bibliographic search was conducted in the literature produced by AA on alcohol and alcoholism. A qualitative investigation was also carried out among AA groups located on the outskirts of the city of São Paulo, Brazil. Interviews were held and several activities undertaken by its members were observed. AA's therapeutic model is conceived as a system in which symbolic reality is fundamental for representing alcoholism as a "chronic and fatal disease" and consequently for constructing the identity of "individuals with alcohol sickness". In fact, anonymity works as a fundamental symbolic mechanism in the healthdisease process experienced within AA. It links directly to constructing the identity of "individuals with alcohol sickness undergoing recovery" and consequently to subjectively reconstructing the fellowship's members.

Se pretende contribuir para la comprensión del papel del anonimato en el modelo terapéutico desarrollado por la hermandad de Alcohólicos Anónimos (A.A.) para dar cuenta de la "enfermedad del alcoholismo". Se ha realizado una investigación bibliográfica en la literatura producida por la hermandad sobre el alcohol y el alcoholismo, así como una pesquisa cualitativa en grupos de A.A. localizados en la periferia de la ciudad de São Paulo - Brasil - con realización de entrevistas y observación de diversas actividades promovidas por sus miembros. Se concibe el modelo terapéutico de A.A. como un sistema cuya realidad simbólica es fundamental en la representación del alcoholismo como una "enfermedad crónica y fatal" y consecuentemente en la construcción de la identidad "enfermo alcohólico". En efecto, el anonimato opera como un mecanismo simbólico fundamental en el proceso saludenfermedad vivenciado dentro de A.A. vinculándose directamente a la elaboración de la identidad del "enfermo alcohólico en recuperación" y, por esta vía, a la reconstrucción subjetiva de los miembros de la hermandad.

La espiritualidad y su relación con la recuperación del alcoholismo en integrantes de Alcohólicos Anónimos (AA)

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Summary: In alcoholism research, the exploration of the spirituality have a great importance. Some authors keep distance from this concept and it has been commonly criticized. However, other researchers (Gorsuch, Connors, Tonigan, and Miller) have agreed in pointing out to this and other variables, like religion for example, as important elements that protect individuals from addiction, also as factors that favor treatment and mediate in long abstinence periods. According to Morjaria and Orford, the assumption of a link between spirituality and alcoholism exist because is one of the principles of Alcoholics Anonymous (AA) foundation. In the present, the work of AA is one of the most popular approaches in recovering from alcoholism, within Mexico and in other countries as well, and although its effectiveness over alcohol consumption is still debatable, not well documented and inconclusive. There is evidence suggesting that a regular participation in the group meetings could benefit a lot of individuals; especially those whose participation in all the activities is more enthusiastic and those who develop more beliefs inside the groups. A key element in AA's philosophy is the acceptance of a spiritual strength that comes from a bigger power than themselves (Higher Power: can be understood as a "whole" or the power represented by God), which helps in the recovery process. AA acknowledge the importance of religious thoughts, and the relevance of spiritual tradition in the recovery of each alcoholic, however, the core of the treatment is not placed on these aspects, but it is on spirituality. According to AA, every individual may have his own definition of spirituality and it is outlined by his personal orientation. In that respect, Forcehimes, Kurtz, and Ketchman said that spirituality is a transformation breakthrough marked by a personal experience of "spiritual awakening", all resulting from regular participation to the meetings and from the daily practice of the twelve-step program. The twelve-step program represents one of the most important components in the recovery strategy of AA and reflects the spiritual nature of the program. DiClemente and Gabhainn have noted that the practice of the steps has fundamental implications in reaching and maintaining abstinence, especially for those who practice them on a regular way. However, available evidence about the benefits that each step brings to the alcoholics is still limited and sometimes controversial. There are very few investigations in Mexico about the role of spirituality in the alcoholic recovery process. AA have not been sufficiently studied and there is a lot unknown about their treatment strategies. The objective of this study is to know if the effectiveness of the practice of the 12 steps, the frequency of their practice, and the experience of the "spiritual awakening" (that AA consider as a consequence of practicing the steps) influence on the maintenance of abstinence in members of AA. The sample was non probabilistic and included 192 AA members from traditional groups (or "an hour and a half" groups, named after the time meetings last) from southern Mexico City area. Individuals were divided in two groups: relapsed and not relapsed. The first group included 49 alcoholics (90 percent of males, 10 percent of females) who relapsed after an abstinence period of three or more months within AA (abstinence mean = 2.4 years). The second group included 143 subjects (86 percent of males, 14 percent of females) who have not relapsed since they entered AA or for a ten year period or longer. To determine the influence of the spiritual principles of the 12 steps program, a question was designed to measure the practice of each one of them, as well as a scale to explore the frequency of such practice. Also, since AA considers the "spiritual awakening" as a result of working with the steps, a question about its occurrence was included. Results showed that not relapsed individuals have practiced significantly more steps (mean=9, SD=4.1) than the relapsed ones (mean=7, SD=4.4) (t=2.304, df=190, p=.02). Results also showed that frequency in the practice of: thinking about events that led to alcoholism (steps 4 and 5), humbleness to accept help from a Higher Power (steps 6, 7, and 11), acceptance of responsibility to reduce the consequences of addiction (steps 8, and 9), and helping other alcoholics (step 12), is significantly different between both groups; not relapsed individuals had a more frequent practice of these steps. Since AA assumes that working the steps leads to experience a spiritual conversion or "spiritual awakening" (it implies a change in the self-concept, in the view of the world, and stop being self-centered), a regression analysis was performed to test this assumption. Results suggested that a greater involvement in steps 4 to 12 -usually considered as steps for action and maintenance- increases 10 percent the probability for experiencing the "spiritual awakening" (p=.000). Besides this experience increases two times the probability for staying sober in not relapsed subjects (Exp[B]=2.095, CI=1.032-4.253, p=.04). No statistical differences were found in the practice of steps 13, but this does not mean that they are not important, for these are the most practiced steps in both groups. However, the fact that relapsed alcoholics put great value upon these steps, points out their willingness to stop consuming (apparently they have accepted being powerless before alcohol, and to surrender their will and life to a Higher Power), but it also underlines their difficulty in attaching to some of the beliefs and activities that AA consider as base to complete the practice the steps and to develop spirituality. Several of these activities are related to elements in the program that mean more action and certain degree of confusion and discouragement for those who focus in staying sober only based on a vague idea of what constitutes the Higher Power. AA recognizes the first three steps as the facilitators of abstinence and as the beginning of the path to "spiritual awakening" through an aid that transcends the individual (Higher Power), but they also emphasize that many times this is not enough for the recovery. Paradoxically, they state that this condition could lead to a feeling of false security that could invite the alcoholic to flirt with the idea of having "just one drink". Therefore, it is not casual that relapsed individuals in the sample of this study focus on practicing the first three steps, though more research is needed to further confirmation. These results allow concluding that spacing out the practice of the 12 steps or not practicing them at all, produces low levels of spirituality, which could be the cause of a relapse. Results also showed that a higher level of spirituality (linked to the practice of more steps) has an important influence on the recovery of alcoholics, particularly for those whose practice of the steps is more regular. The sample of this study showed that its particular way to develop spirituality (spiritual awakening) and therefore maintain abstinence requires of a process that involves cognitive, emotional, and behavioral activity (steps 4-12), and not only to embrace the conviction of alcoholism as a disease susceptible of being cured (steps 1-3). Finally it is important to indicate that the 12 steps program represent a particular way of expressing spirituality, and that they are limited to specific cognitions and practices; thus, more research is required to replicate these results with other measures of spirituality.