Obvious benefits but hidden costs: A critical exploration of the impact of adopting the "master narrative" in Alcoholics Anonymous.

INTRODUCTION: New members of Alcoholics Anonymous (AA) typically acquire a distinct "alcoholic" identity, including AA-specific understandings of their "alcoholism" and what it means to be in recovery. Although much qualitative research on AA has presented the experiences of members who have embraced this identity and have been wholly praising of AA, other theorists have been strongly critical of the organization, often arguing that it emulates a cult. To contribute towards reconciling these competing bodies of research, the current study aimed to critically explore the impact of adopting AA's master narrative. METHODS: The study involved 19 prospective, in-depth semi-structured interviews with six AA members recruited from meetings across Sydney, Australia. Data were analyzed thematically using a master narrative theoretical framework. RESULTS: The study identified three core components of AA's master narrative: (1) Powerlessness over alcohol ("alcoholics" are powerless over alcohol); (2) Internalized pathologization ("alcoholics" are mentally and emotionally sick, above and beyond their problems with alcohol); and (3) AA as the only solution for wellness (involvement in AA is the necessary requirement for "alcoholics" to become and remain well). Although most participants emphasized the positive experiences from internalizing the AA narrative, our analysis also revealed potentially negative ramifications of this narrative on their self-conceptions and worldviews that were seemingly unrecognized by participants themselves. CONCLUSIONS: The master narrative framework facilitated a critical and balanced exploration of AA members' experiences. Although AA's master narrative is valuable for members, it could also carry costs that need to be mitigated by resources both inside and outside of AA.

Health and social interventions in the context of support and control: The experiences of marginalised people who use drugs in Australia.

People who use illicit drugs frequently become targets for welfare intervention, often positioned both as complicit in the reproduction of intergenerational poverty and marginalisation, and as sources of hope for interrupting such patterns. This article draws on empirical research exploring the experiences of highly marginalised people with histories of illicit drug-use to investigate how they negotiate service encounters in the context of the participants' previous experiences with welfare interventions. In doing so, the article seeks to texture the conception of the support and control nexus, drawing out the systemic and service level factors of welfare services which inhibit people who use drugs from benefitting from available support. We conducted 12 in-depth interviews with participants subject to interventions by health, social or legal services between July and September 2018. All interviews were audio-recorded, transcribed verbatim and coded in NVivo. Transcripts were analysed using a grounded theory approach where data were subject to an iterative process of constant comparisons to identify emergent themes and theoretical concepts. The findings suggest that the blending of welfare services and systems of control has unintended and often negative consequences for highly marginalised people. In effect, the drug treatment programme's aims of assisting people to reduce harm and increase stability are significantly undermined by control mechanisms such as mandatory reporting policies. A better understanding of the ways in which welfare service processes alienate marginalised people from seeking support, as well as from benefitting from the support available, might provide a way to address these concerns.