Group Observation: Micro, Mezzo, and Macro Levels Q1. What is your role in this group? (Observer, facilitator, member, etc.)

Upon the request of a friend, I chose to observe an open Alcoholics Anonymous (AA) meeting last year. Unlike a closed meeting, which is solely reserved for people who have admitted to have an alcohol addiction, AA open meetings are open to addicts contemplating recovery, friends, family members, and outside observers. I had previously attended an open meeting several years ago to support another friend to support another person. This meeting, I was an observer, acting as a supporter, as well as a critical analyst, based on my greater knowledge of social work and psychology. Since I had learned more about therapy, I was curious to see how the dynamics operated in the meeting, as well as to accompany my friend by her request.

AA has created open meetings for several reasons. First of all, recovery from alcoholism is a complicated process. Many people spend a long period of time contemplating recovery before they actually make the first step of abandoning alcohol. AA believes it is important for alcoholics to have meeting formats to bring friends and family members to, to support their loved one’s recovery. It also allows people like myself observing meetings for an academic purpose to demystify the 12-step process. This makes it different from traditional group therapies facilitated by a trained counselor, which seldom are open in any form to the public.

Q2. What type of group is it? How do you know? What is the group’s purpose and how was the group generated?

Alcoholics Anonymous is a support group for recovery from substance abuse. It specifically proclaims itself as such. It is unique in that rather than being facilitated by a trained therapist, it is facilitated by former addicts. The program has a very specific process of proceeding through different steps and stages, a bible of recovery, and this format has formed the basis of most existing 12-step programs. The group was formed by an addict, and designed based upon what had worked for him, versus evidence-based medicine or a specific therapeutic theory.

AA is a very practical program. It is based upon the idea that once someone is addicted, the addict should not continue drinking, even socially. The approach of AA is based upon the experiences of addicts, and uses mentorship of other persons in recovery to further its aims. Although other psychological accomplishments such as recovering from depression may be part of recovering from addiction, the group does not offer treatment for additional issues.

Q3. Describe the environment. Do people seem comfortable here?

The AA meeting took place in the basement of a church. There was coffee being served. Folding chairs were set up in a table. The comfort level of various members varied widely. Some people had coffee, chatted with other members and joked before the meeting took place. Others were silent and mainly looked...

Some people evidently there with their partners seemed very at ease; there was almost a party-like atmosphere, as they introduced them to their friends in the group.
But because open meetings encompass such a wide array of individuals in all phases of recovery, some people did seem very uncomfortable with the dynamics of the meeting if they did not know anyone. Some of these people, of course, may have been alcoholics who were not willing to make a change, given this was an open meeting. Also, just like any meeting with regular participants, it is also possible that there may have been some discomfort with the interpersonal dynamics, based upon past experiences. However, the combination of coffee, facilitators who identified as fellow substance abusers with the participants, and the close atmosphere of the church basement all fostered a more relaxed atmosphere than a clinical environment. There was, in other words, a social aspect to the interactions beyond its therapeutic purpose (or the social dynamic might have...…or give women more freedom to talk about their experiences with sexual abuse and other issues which may have triggered their alcoholism.

All AA meetings are led by persons in recovery. This meeting chair was very helpful in directing different persons to speak. They were careful about giving the participants enough time to express themselves, but also keeping the meeting moving forward. The facilitator was also very helpful in talking about and explaining AA to non-members. In the groups I witnessed, there was very little interpersonal tension that needed to be facilitated. The dominant group norm was being supportive of recovery, and using acronyms common to AA. The Serenity Prayer was said during the meeting. I know from past experience that some people have had issues with the inclusion of a religious prayer in a support group that is not explicitly religious, since the prayer makes reference to God, but everyone in the group seemed very comfortable with its reference to a higher power.

Q6. Is this group addressing community needs at a micro, mezzo, or macro level? How do you know?

This group addresses community needs, in my opinion, primarily at the micro level, given that the individual is considered to be in control of his or her recovery, and primarily responsible for making the decision not to drink. This contains some problematic assumptions, however. First and foremost, it disregards the fact that certain individuals may have fewer financial and logistical resources to combat depression and insecurity, which can lead to alcoholism. It also disregards the fact that poorer and disenfranchised individuals may have less access to healthcare or support structures to help them through recovery.

Thus, AA does not necessarily address problems at a macro level, although it does strive to offer a mezzo or group-level approach. It may be helpful for individuals on a personal level, but it does not address wider societal issues such as poverty on a macro level that may make certain individuals more prone to abuse…