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Kidd JD, Kaczmarkiewicz R, Kreski NT, Jackman K, George M, Hughes TL, Bockting WO. A qualitative study of alcohol use disorder psychotherapies for transgender and nonbinary individuals: Opportunities for cultural adaptation. Drug Alcohol Depend 2023; 248:109913. [PMID: 37182356 DOI: 10.1016/j.drugalcdep.2023.109913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Transgender and nonbinary (TGNB) populations experience high rates of hazardous drinking (HD) and alcohol use disorder (AUD) as well as unique treatment barriers. This is due, in-part, to discrimination and stigma within and outside of the healthcare system. Cultural adaptation of clinical interventions can improve outcomes for marginalized populations, but no such adapted interventions exist for AUD among TGNB individuals. This study sought to understand how TGNB individuals perceive currently available AUD psychotherapies and to generate knowledge about potential areas for cultural adaptation. METHODS As part of a qualitative study of HD among TGNB individuals (N=27), participants were asked to imagine that they were clients in psychotherapy vignettes corresponding to cognitive behavioral therapy, motivational enhancement therapy, and twelve step facilitation. Interviews were audio-recorded and professionally transcribed. A coding team used an iterative codebook to guide coding. Categories emerged from this process that reflected participants' perceptions and allowed for the identification of potential cultural-adaptation targets. RESULTS Across all three psychotherapies, participants wanted therapists to explicitly discuss gender identity and culturally salient HD risk factors for TGNB individuals (e.g., discrimination, stigma, gender dysphoria). There were also modality-specific recommendations to incorporate principles of trauma-informed care into cognitive behavioral therapy, avoid motivational enhancement therapy exercises that oversimplify decision-making, and recognize that the twelve-step-facilitation concept of "powerlessness" may conflict with how many TGNB people see themselves. CONCLUSIONS These findings highlight areas for cultural adaptation that can be evaluated in future intervention trials in an effort to improve psychotherapy acceptability and efficacy for TGNB individuals.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Roma Kaczmarkiewicz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA.
| | - Noah T Kreski
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY10032, USA.
| | - Kasey Jackman
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA; New York-Presbyterian Hospital, 622 W. 168th Street, New York, NY10032, USA.
| | - Maureen George
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
| | - Walter O Bockting
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY10032, USA.
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Glassman HS, Moensted M, Rhodes P, Buus N. The politics of belonging in Alcoholics Anonymous: A qualitative interview study. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 70:33-44. [PMID: 34761820 DOI: 10.1002/ajcp.12568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
A prevalent critique of Alcoholics Anonymous (AA) is that members must adopt an inflexible illness narrative, taking on an "alcoholic" identity and performing a set of practices to address this condition. Conversely, a small body of research suggests that, rather than comprising the uniform adoption of a rigid narrative, integration into AA is achieved by negotiating individual beliefs, values, and preferences with the AA model. To investigate such processes of negotiation, the current study aimed to explore the politics of belonging in AA. The study involved semi-structured interviews with 15 AA members recruited from meetings across Sydney, Australia, and data were analyzed thematically. Findings illustrated how participants navigated the politics of inclusion/exclusion within AA. While some aspects of AA were found to be negotiable by participants, a non-negotiable aspect of AA ideology that emerged was the axiom that "alcoholics" have no control over alcohol and therefore should maintain abstinence. Findings raise questions about how the politics of belonging in AA may shift over time following broader patterns of societal change.
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Affiliation(s)
| | - Maja Moensted
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney and Centre for Social Research in Health, Sydney, New South Wales, Australia
- Faculty of Arts and Social Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Niels Buus
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash, Victoria, Australia
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
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Sally Glassman H, Rhodes P, Buus N. Exiting Alcoholics Anonymous disappointed: A qualitative analysis of the experiences of ex-members of AA. Health (London) 2020; 26:411-430. [PMID: 32993383 DOI: 10.1177/1363459320961438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alcoholics Anonymous (AA) is an NGO designed to support anyone who identifies as alcoholic to stop drinking alcohol. Existing qualitative research in this field has primarily reflected the experiences of those who have conformed to AA ideology and had positive experiences in AA. To address this, the current study aimed to explore the perspectives and experiences of individuals who have left AA with some degree of disappointment. The study involved semi-structured interviews with 11 ex-members of AA from America, Australia, and England, who were recruited from several private social media platforms. The study used an interactionist conception of social career involving conversion and deconversion, and data were analyzed thematically. Findings included that while participants experienced some genuinely positive aspects of AA, they retrospectively believed that they remained in AA because they had been indoctrinated into a particular way of understanding themselves. Moreover, findings highlighted participants' concerns with the people, ideology and practices within AA that ultimately led to their dissociation from the community. Our findings demonstrate a disparity between the idealistic principles in AA and the actual experiences of participants, and this is discussed in relation to the breadth of possible experiences across varying groups and AA's unregulated peer-to-peer framework.
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Affiliation(s)
| | | | - Niels Buus
- University of Sydney, Australia.,St. Vincent's Hospital, Australia.,St. Vincent Private Hospital, Australia.,University of Southern Denmark, Denmark
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