Spirituality and Purpose in Life in Alcoholism Recovery
STEPHANIE CARROLL, PH.D.
California Schoolof ProfessionalPsychology,Berkeley/Alameda,1005 AtlanticAvenue,Alameda, California 94501
ABSTRACT. This studyexaminesthe relationshipbetweenspiritual-
ity and recoveryfrom alcoholism.Spiritualitywas definedas the ex-
tent of practiceof AlcoholicsAnonymousSteps 11 and 12 and was
measuredby a Step Questionnairedevelopedby the researcher.Step
11 suggests prayerand meditationand Step 12 suggests assistanceof
other alcoholics.Expresseddegreeof purposein life was alsoseenas
a reflection of spirituality.It was postulatedthat the extentto which
Steps 11 and 12 were practicedwould be positivelycorrelatedwith
the extentof purposein life reportedby 100 AlcoholicsAnonymous
T PROGRAM
ofAlcoholics
Anonymous
(AA)iswas developedby Crumbaughand Maholick (1964) as a
dominant treatment initiative for alcoholism (Gla-
ser and Ogborne, 1982;Saxe, 1983). The basisof recov-
ery in AA is spiritual growth throughthe practice of
certain spiritualprinciples.Theseprinciplesare contained
in the 12 stepsof the programand include dependence
upon a self-defined Higher Power, self-examination,
prayerand meditation,and assistance of others.It is the
thesisof this studythat the extentto which the AA steps
are practicedwill be positivelycorrelatedwith a senseof
meaningand purposein the lives of AA members.
Spiritualityas a factor in alcoholismrecoveryhas been
neglectedin research. Yet, as Clinebell (1963) states,
"one of the significantfactorsin the etiologyof alcohol-
ism is the vain attemptof the personto satisfydeepreli-
giousneedsby meansof alcohol" (p. 487). Examination
of this aspectof alcoholismis oftenhampered,in that cli-
niciansand researchersdo not generally contactsuccess-
fully recoveringalcoholics.However, studieshave been
doneregardingAA's effectiveness. For example,a 6-month
follow-upof 900 adultswho had undergonetreatmentfor
chemicaldependencyin 1980 showedthat 73% of those
who regularlyattendedAA remainedabstinent,compared
with 33% of the nonattenders(Hoffmann et al., 1983).
Purposein life
Alcoholicsare often describedas depressedand self-
destructive.This suggests
that they may alsofeel a lack of
Received: June 18, 1991. Revision: November 1, 1991.
Correspondenceshouldbe addressed to the authorat 1651Greenview
Lane, HuntingtonBeach,Calif. 92649.
297
members.The major findings of this study are significantpositive
correlationsbetweenpractice of Step 11 and purposein life scores
(r = .59, p < .001) and betweenStep 11 and length of sobriety
(r = .25, p < .el). Numberof AlcoholicsAnonymousmeetingsat-
tended was significantly correlated with purpose in life scores
(r = .24, p < .el) andlengthof sobriety(r = .25, p < .el). These
findingssuggestthat a senseof purposein life increaseswith con-
tinuingsobrietyand practiceof the spiritualprinciplesof Alcoholics
Anonymous.(J. Stud. Alcohol 54: 297-301, 1993)
purposeor meaningin life. The Purpose-in-LifeTest(PIL)
measureof Frankl's conceptof existentialfrustration,or
lack of perceivedmeaningin life. Crumbaughand Mahol-
ick (1964) administeredthe PIL to a groupof hospitalized
alcoholicsand the alcoholicshad the lowestmeanrating
of all five groupstested.In a later cross-validation of the
PIL test, Crumbaugh(1968) again found that, with the
exceptionof a groupof 18 hospitalizedpsychotics,of the
10 groupsstudied,alcoholicshad the lowestPIL ratings.
A lowered senseof meaningin life has been seen as
both the causeand the effect of alcoholicdrinking(Cline-
bell, 1963). A majoraspectof spiritualgrowthin AA is to
addressthis lack of purposethroughassistance to others.
Clinebellalsoviews a loweredsenseof meaningas indica-
tive of unmetspiritualneeds.He liststhreeaspectsof these
needs:(1) the need for an experienceof the transcendent
and the numinous;(2) the need for a senseof meaning,
purposeand value in one's existence;and (3) the need for
a feelingof deep trust and relatedness to life. Similarly,
Kurtz (1979) sees alcoholismas a misguidedthirst for
transcendence and believes that it is the alcoholic's denial
and misunderstanding of spiritualneedsthat is at the root
of alcoholaddiction.He believesthat alcoholics are trying
to achievea quality of life througha quantityof experi-
enceswith alcohol. Thus, the alcoholic'slack of purpose
in life can be seenas a mental and spiritualimbalance
(Thune, 1977), and drinkingcan be seenas an attemptto
restorethis balancein that, throughdrinking, the alco-
holic experiences a temporary,but highly valued,feeling
of unity (Clinebell, 1963).
Althoughnot discussingAA, Bateson(1971) notedthe
impactof issuesof controlon alcoholismand tied the im-
portanceof theseissuesto spiritualchanges.He stated:
298 JOURNAL OF STUDIES
Testingof self-controlleadsback into drinking[and] the his-
toric battle with the bottle... endsup in a "kiss and make
friends".... This is a double bind correctlyfoundedupon
the alcoholic's dichotomousepistemologyof mind versus
body.He is forcedby thesewordsback and backto the point
at which only an involuntarychange in deep unconscious
epistemology--aspiritualchange--will make the lethal de-
scriptionirrelevant.(pp. 13-14)
Spiritualityand the principlesof AA
AA emphasizesthat it is not a religiousorganization.
When God is mentioned in AA literature, it is often with
the qualification"as you understandHim," and Higher
Power is often the preferredterm. This is important in
that a numberof AA membersare atheistor agnosticand
define the powerof the group, or of AA as a whole, as a
powergreaterthanthemselves. One of AA's founders,Bill
W. (AlcoholicsAnonymous,1976), states:
We find that no one needhavedifficulty with the spirituality
of the program.Willingness,honesty,and open-mindedness
are the essentialsof recovery.... Most of our experiences
are what the psychologist William Jamescalls the "educa-
tional variety" becausethey developslowlyover a periodof
time.... With few exceptionsour membersfind that they
havetappedan unsuspected innerresourcewhichthey pres-
ently identify with their own conceptionof a Powergreater
than themselves.(pp. 569-70)
AA's view of changethroughSteps11 and 12. AA lit-
eratureemphasizes the alcoholic'segocentricity,
low frus-
tration tolerance and demand for control. These are also
someof the characteristicsthat have been found empiri-
cally to be descriptiveof alcoholics.The AA book Twelve
Stepsand TwelveTraditions(1952) givesthe followingde-
scriptionof an alcoholic'spersonality:
The chief activator of our defects had been self-centered
fear--primarily fear that we would lose somethingwe al-
readypossessed or wouldfail to get somethingwe demanded.
Living on a basisof unsatisfieddemands,we were in a state
of continualdisturbanceand frustration(p. 76).... Our de-
mandfor emotionalsecurity,for our own way, had constantly
thrown us into unworkablerelationswith other people....
Eitherwe hadtried to play God anddominatethoseaboutus,
or we had insistedon being overdependent uponthem, being
quite unableto seethat our unreasonable demandshad been
the cause.(p. 115)
The way in which AA suggestschangingtheseperson-
ality characteristics,
or "defectsof character,"is through
the twelve steps. Steps 10, 11 and 12 are called the
"maintenancesteps" and are seenas the most important
for spiritualgrowth and, therefore,for sobriety.They are
as follows (AlcoholicsAnonymous,1976, pp. 59-60):
ON ALCOHOL / MAY 1993
10. Continued to take personalinventory and when we were
wrong promptlyadmittedit.
11. Soughtthroughprayerand meditationto improveour con-
sciouscontactwith God as we understoodHim, praying
only for knowledgeof His will for us and the powerto carry
that out.
12. Having had a spiritual awakeningas the result of these
steps,we tried to carry this messageto alcoholics,and to
practicetheseprinciplesin all our affairs.
Thus, it is throughan emphasisupon self-honesty,pa-
tience, tolerance, kindness and humility that spiritual
growthis begun.The prerecoveryalcoholicis likenedto a
"tornado roaringthroughthe lives of others" (Alcoholics
Anonymous,1976, p. 82), but that with Step 10 "we have
enteredthe world of the Spirit.... And we haveceased
fightinganythingor anyone--evenalcohol" (p. 84).
Method
Subjects
The subjectswere 100 (51 male) membersof Alcohol-
ics Anonymous.Approximately20 differentAA groupsin
northernCalifornia were attendedby the researcherand
memberswere askedto respondto the Step Questionnaire
(see the Appendix)and the PIL. The responserate was
73%. The subjectsrangedin age from 26 to 81. The me-
dian age was 42 and the majority of the subjectswere
white. Lengthof sobrietyrangedfrom 7 daysto 33 years,
with a median(-+ SD) of 3 -+ 7 yearsof sobriety.One-
third of the subjectshad up to 18 monthsof sobriety,an-
other third had between 18 monthsand 5 yearsand the
last third had from 5 to 33 years of sobriety.The mean
level of educationwas 3 yearsof college;76% of the sub-
jectshad at least I year of collegeand 48% had collegeor
graduatedegrees.
Measures
The Purposein Life Test. This test was developedby
Crumbaughand Maholick (1964) to measureempirically
the conceptof meaningand purposein life, as it appears
in the writings of Viktor Frankl. It was necessaryto
slightlyrewordfour PIL questions(no.'s 6, 14, 16 and 18)
so that the subjectswould, for example,be able to deter-
mine if the questionconcernedtheir lives beforeor after
gainingsobriety.A reliabilityanalysisof the modifiedPIL
yieldedan alphacoefficientof .89.
StepQuestionnaire.A 38-itemquestionnaire designedto
measuretheextentto whichAA memberspracticeSteps11
and 12 wasdevelopedby theresearcher (seetheAppendix).
Step 11 assessment and scoring. Measurementof Step
11 includedassessment of both behaviorand affect. Step
11 behaviors(the first nine itemsof the questionnaire)
in-
cludeda variety of spiritualpractices,suchas meditation
 CARROLL 299

TABLE1. Correlationsbetweensteps11, 12, purposein life (PIL) and TABLE2. Beta weightsfor predictorvariablesof purposein life scores
lengthof sobriety(LOS)
Variable Beta wt Signif. level
12 PIL LOS
Step 11 .53 .001
Step11 .24* .59* .25* AA meetings .20 .02
Step 12 - -.01 .22 Lengthof sobriety .15 .10
PIL -.01 - .31' Age .15 .09
Step 12 -.09 .35
Note: Becauseof the correlationalnatureof this study, .01 was chosen
Number of slips -.07 .38
as the cutofffor level of significance. Years of education .06 .51
*p < .01. *p < .001.

or spendingtime in nature.Items were answeredin terms
of frequencyof participationper day, week, month or
year.The researcherlater constructed a frequencydistri-
bution table of responsesto each item. Each answerwas
then assigneda scorefrom 1 to 5 accordingto frequency
of participation.Step 11 affect included13 Likert scale
items, also scoredfrom 1 to 5, askingthe extentto which
the individualfeels he or she has, for example,peaceof
mind or faith in a Higher Power.
Step12 assessment andscoring.Step 12 (items10-25of
the questionnaire)includedboth frequentand infrequent
Step 12 activities.These activitieswere scoredin the
samemanneras the Step 11 behaviors.
The reliability of the questionnairewas basedon assess-
ment of internalconsistency throughdeterminationof the
alpha coefficient.The alpha coefficientfor the Step 11
scalewas .78 and the Step 12 scalealphacoefficientwas
.59. The alphacoefficientfor the StepQuestionnaire over-
all was .78. The constructvalidityof the questionnaire was
ascertained by interjudgeagreement on inclusionof items.
Procedures
The researcher
attendedapproximately
20 AA meetings
at various northern California locations. At the end of the
meetingthe researcher describedthe purposeof the study
and, after the meeting,distributedthe Step Questionnaire
and the PIL. The items took approximately15 minutesto
complete and the subjects were given stamped, pre-
addressedenvelopesto return the survey and stamped,
pre-addressed postcardsto mail separatelyif a summary
of the results was desired.
Results
Hypotheses
Hypothesis1. There will be a significantpositivecorre-
lation betweenthe extentto which AA memberspractice
Steps11 and 12 and PIL scores.
The extent to which subjectsreported practicingStep
11 was significantlycorrelated(r = .59, p < .001) with
PIL scores.However, the extent to which Step 12 was
practicedwasnot significantly correlated(r = -.01) with
PIL scores(seeTable 1). The practiceof Steps11 and 12
combined did show a significant correlation (r = .51,
p < .001) with PIL scores.Assumptionsunderlyingthe
use of Pearson's r were met.
A stepwisemultiple regressionshowedthat Step 11 ac-
counted for 32% of the variance in PIL scores(R = .56,
p < .001). Numberof AA meetingsattendedand Step 11
practicecombinedaccountedfor 35% of the variancein
PIL scores(R -- .60, p • .001). A comparisonof the
beta weightsof the predictorvariablesshowedthat Step
11 and numberof AA meetingsattendedwere the only
significantpredictorvariablesof PIL (seeTable 2).
Hypothesis2. There will be a significantpositivecorre-
lation betweenlength of sobrietyand PIL scores.
As indicated in Table 1, length of sobriety and PIL
scoreswere significantlycorrelated(r = .31, p • .001).
Assumptions underlyingthe useof Pearson'sr were met.
Additional correlations. Number of AA meetings at-
tended,which is a partial measureof Step 12, was signif-
icantly correlated with length of sobriety (r = .25,
p • .01), purposein life (r = .24, p • .01) and number
of slips (r -- -.27, p < .01).
Group characteristics.More than 50% of the subjects
reportedpraying twice a day, meditatingonce a day and
readingspiritualliteraturethree times a week. Over 50%
also reportedthat, on a weekly basis, they spenttime in
nature,listenedto spiritualmusicand talkedto their spon-
sors. More than 50% interacted with art once a month and
did not attend church. As for attending AA meetings,
93% attendedmeetingsat leasttwice a week and 57% at-
tendedmeetingsat least five times per week. Sixty-five
percenthad not had a drink or "slip" sincejoining AA
and 74% had completedSteps4 and 5 (writing and dis-
cussinga "moral inventory" of one's past).
Discussion
The major finding of the presentstudywas that the ex-
tent of practiceof Step 11 was positivelycorrelatedwith
both purposein life (PIL) and length of sobriety.As both
purposein life and lengthof sobrietywere associatedwith
Step 11, one might wonderif greater purposein life is
morerelatedto lengthof sobrietythan to practiceof Step
11's prayerand meditation.However,this is not indicated
in that PIL was more highly correlated with Step 11
(r = .59, p < .001) than with length of sobriety
300 JOURNAL OF STUDIES ON ALCOHOL / MAY 1993

(r = .31, p < .001). Also, purposein life was signifi- Volunteerto assistalcoholics who are having
cantlypredictedin the multipleregressionby Step 11, but difficulties(visit or call on phone,take to a
meeting,etc.) ()()()()
notby lengthof sobriety.However,it is importantto keep
in mind the limitationsof a correlationaldesignand of IN YOUR CURRENT PERIOD OF SOBRIETY, HOW MANY TIMES HAVE
self-selection
bias. Also, AA membersmay be a select YOU SERVEDIN THE FOLLOWING CAPACITIES.
9 For example, if
populationof alcoholicsand not representativeof pre- or you were secretaryfor two differentmeetings,write in a 2. Or,
for example, if you once served as coffee maker for three
postrecoveryalcoholicsin general. months, write in a 1.
The findingthat Step 12 was not significantlycorre- How MANY TIMES IN
latedwith purposein life or lengthof sobrietyneedsto be CURRENT PERIOD OF SOBRIETY?
AA secretaryor treasurer ( )
interpretedcautiouslyas the definitionof Step12 work is Speaker ( )
open to interpretationand is difficult to measure.A more Coffeemaker ( )
reliablemeasureof Step 12 practiceanda morecompre- Literatureperson ( )
Centralofficeworker ( )
hensivemeasureof spiritualityand existentialconcern Hospital& institutionvolunteer ( )
than the PIL would be helpful for further research.Pro- Generalservicerepresentative ( )
fessionalsrecommending AA mightalsopayspecialatten- Assistedat otherAA activity ( )
AttendedAA conference ( )
tion to the spiritualissuesof their clientsand encourage Goneon a 12thstepcall ( )
discussion of the extentof clients'practiceof Steps11 Sponsor ( )
and 12. Continuinginvestigation throughbothclinicaland Unofficialsponsor ( )
research avenues into what it is about AA that works so
CIRCLE THE EXTENT TO WHICH YOU
well couldcertainlycontributeto an understanding
of the FEEL YOU GENERALLY HAVE:

processof recoveryfrom the diseaseof alcoholism. NONE Very little O.K. Good Quite a bit
Acceptanceof life
as it comes 1 2 3 4 5
Appendix: Step Questionnaire Peace of mind 1 2 3 4 5

LENGTH OF CURRENT PERIOD OF SOBRIETY:

Acceptanceof others 1 2 3 4 5
Connection to a
MONTHS __ YEARS __
Higher Power 1 2 3 4 5
Total length of time as a memberof AA: Months__ Years__ Patience 1 2 3 4 5
Age __ Male __ Female__ Noncontrollingattitude I 2 3 4 5
Highestgradecompletedin school__
Numberof "slips"__ Haveyoudonea 4th and5th step?Yes__ CIRCLE THE EXTENT TO WHICH YOU
No__ FEEL YOU GENERALLY HAVE:

NONE Very little O.K. Good Quite a bit

In your current period of sobriety, and within the last six Connection to all
months, please LISTNUMBEROF TIMESPERDAY, WEEK,MONTH, living things I 2 3 4 5
Self-restraint I 2 3 4 5
ORYEARthat you participatein the followingactivities.Write in
Faith in a Higher Power I 2 3 4 5
only one numberper line.
DAY Week Month Year Connectionto people 1 2 3 4 5
Pray () () () () Satisfyingprayerlife I 2 3 4 5
Gratitude I 2 3 4 5
Meditate () () () () Delight in the wonder
ReadAA literatureor otherspiri- of life I 2 3 4 5
tual literature () () () ()
Consideryour spiritualcondition References
(or do a "spot-check
inventory") () () () ()
Spendtime in nature(for example, ALCOHOLICS
ANONYMOUS,
3d Edition,New York:Alcoholics
Anony-
mous World Services, Inc., 1976.
walk on the beach or in the forest) () () () ()
Interact with art or artistic endeav- BATESON,
O. Thecybernetics
of "self": A theoryof alcoholism.
Psy-
chiatry34: 1-18, 1971.
ors (visit museum,paint, etc.) () () () ()
Attend church
CLINEBELL,
H.J., JR. Philosophical-religious
factors
in theetiologyand
() () () () treatmentof alcoholism.Q. J. Stud. Alcohol 24: 473-488, 1963.
Listento musicyou consider CRUMBAUGH, J.C. Cross-validation
of purpose-in-lifetest basedon
spiritual () () () () Frankl'sconcepts.
J. individ.Psychol.24: 74-81, 1968.
Talk to your sponsoraboutyour CRUMBAUGH, J.C. ANDMAHOLICK,
L.T. An experimentalstudyin ex-
program () () () () istentialism:
The psychometric
approachto Frankl'sconceptof
Attend AA meetings () () (-) () noogenicneurosis.J. clin. Psychol.20: 200-207, 1964.
Approachnewcomersat meetings () () () () GLASER,
F.B. ANDOGBORNE, A.C. DoesA.A. really work?Brit. J.
Addict. 77: 123-129, 1982.
Engagein non-AA serviceto oth-
HOFFMANN,N.G., HARRISON,P.A. AND BELILLE, C.A. Alcoholics
ers (for example,assistthose
elderlyor homeless,
or partici- Anonymousafter treatment:Attendanceand abstinence.Int. J. Ad-
pate in churchactivities such as dict. 18: 311-318, 1983.
Bible studyor teachingSunday KURTZ,E. Not-God:
A Historyof Alcoholics
Anonymous,
CenterCity,
School) () () () () Minn.: Hazelden EducationalServices, 1979.
 CARROLL 301

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