AA groups do not usually modify their approaches based on participant age, but seniors with alcohol abuse problems may experience AA differently from younger participants and may need to emphasize certain aspects of AA over others. Since little research has focused on elderly persons in recovery, we conducted a study comparing the perceptions and needs of 26 young adults ages 20 to 40 to those of 25 older adults ages 65 and up, all from outpatient AA groups in the Southeastern U.S. All subjects had been in AA for six months or less. The study revealed some surprising differences between younger and older adults in AA—differences with clear implications for best practices in substance abuse treatment.
Learning about AA
Many older adults were referred to AA by their medical doctors, with half entering AA because of medical problems caused or made worse by their alcohol abuse. But almost none of the younger adults reported alcohol-related medical problems. Instead, the younger adults were generally referred to AA by their employers, with 40% reporting they had problems at work because of their drinking. In contrast, almost no seniors had work concerns.
Younger adults also had many more alcohol-related legal issues, with only 4% of the seniors entering AA in response to court mandates or other legal entanglements.
These differences likely reflect stage-of-life variations between younger and older adults, with younger adults more often in the workforce and older adults generally retired. The greater frequency of legal problems among younger adults in AA also reflects their greater use of illicit drugs compared with the elderly. Thus, younger persons were referred to AA by drug courts and more often had both alcohol and drug abuse concerns from which to recover, whereas seniors mainly had problems with alcohol alone.
Relationships in AA
There was no difference between the two groups regarding whether participants had obtained an AA sponsor. However, of those who did not have a sponsor, many of the younger adults reported being nervous about asking someone to sponsor them, but not a single senior reported nervousness as a reason. This suggests that younger adults may need more prompting or coaching to help them find sponsors.
More broadly, problems connecting with all other AA members remained a consistent concern for young adults, with only 10% even believing that forming friendships was an important part of being in AA. In striking contrast, the vast majority of seniors believed that friendships in AA constituted a significant part of being in the program and, unlike the young adults, most seniors were actively seeking friendships in their AA group. Younger persons also reported being far more uncomfortable than the elderly in attending AA meetings.
These relationship issues suggest that the young adults, especially early in recovery, may lack the social skills needed to integrate quickly into an unknown group of persons or within an unfamiliar interaction format. It has long been obvious to us that many younger persons are not comfortable sharing during AA meetings. It is possible that this discomfort arises not only from a lack of social skills, but also from the fact that a larger percentage of young adults are court-ordered into AA. If court-ordered, they may feel as though they do not belong among the people who are attending AA more willingly and enthusiastically.
Because of the critical nature of building a sober social support network for sustained recovery, it appears that younger persons in AA may be at much greater risk of relapse because of their lack of interest, nervousness, and discomfort in connecting with other AA members. Clearly, deliberate attention may be needed to help younger adults in AA to form personal bonds within their AA group and to assist them in connecting with a recovery support network, better promoting their recovery and maintenance of sobriety.
Difficulties encountered with AA
There were several significant differences between the age groups regarding logistical difficulties in attending AA, with all problems disproportionately affecting the seniors. For example, 60% of the seniors said that scheduled meeting times presented a difficulty for them; half believed that meeting locations made it hard for them to attend AA; and half also said they had difficulty finding transportation to make it to AA meetings as a result of personal mobility problems or no longer having a driver’s license. Very few of the younger persons indicated any such difficulties.
These starkly contrasting findings suggest that seniors need meetings closer to where they live and recreate, and in disability accessible locations such as senior centers or retirement communities. In the absence of such meetings, it is likely that some seniors in need of AA are unable to participate in the program.
Seniors also seem to prefer morning and daytime AA meetings and may dislike evening meetings; some have night vision problems and simply cannot drive to an evening meeting. The opposite applies to most younger persons, who tend to work during the day and have little trouble being alert or driving at night. The idea arises, then, to promote meeting locations and times that can better accommodate senior citizens who are seeking recovery from alcohol problems.
Overall attitudes toward AA
Overall attitudes toward AA also differed substantially between younger and older members, predominantly suggesting that the younger members are less satisfied with what AA offers them. For example, a full 20% of the younger group felt that AA was a waste of time, but none of the elderly persons felt this way. All of the seniors, but only 75% of the younger adults, felt that AA helped them to achieve sobriety. The seniors rated their overall satisfaction with AA a full point higher than the young adults on a 10-point scale. Lastly, 80% of seniors believed that AA was meeting their support group needs, compared to only 35% of the young adults.
In only one area were the older AA members less satisfied than the young adults. The large majority of seniors felt that their AA group did not understand their individual issues, whereas less than half of the young adults mentioned this problem. Other researchers have demonstrated that older adults tend to feel more comfortable in group settings made up of people their own age, because having age-matched peers allows for easier peer bonding and more readily fosters the establishment of peer sobriety networks. But AA is known to have less than 20% seniors in its membership. Greater attention to the logistical issues that appear to be preventing older adults from attending AA may eventually increase the number of seniors in the program and better meet their needs for same-generation peer support.
Future research with a larger sample is needed to explore the differences we found in greater depth, to confirm their presence in a wider geographic area, and to ascertain whether such differences based on age also affect patients who attend 12-Step based inpatient or residential treatment programs. Yet several provocative findings emerged from the outpatient AA survey we conducted—findings that suggest practical strategies to help AA have a more powerful impact on the sobriety of both the younger and older persons who attend.
Edward J. Cumella, PhD, is retired from private practice and hospital administration and now teaches students pursuing the MS in psychology at Kaplan University online. Christopher Scott received his BS and MS in psychology with a concentration in addictions/substance abuse from Kaplan University. His experience in addiction recovery is both personal and professional, working with others in overcoming their addictions.
July 31, 2014 by Edward J. Cumella, PhD, and Christopher B. Scott, MS
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