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Enfermería Global

versión On-line ISSN 1695-6141

Enferm. glob. vol.16 no.47 Murcia jul. 2017  Epub 01-Jul-2017 


Perspective spirituality in members of alcoholics anonymous: pilot study

Linda Azucena Rodríguez-Puente1  , María Magdalena Alonso-Castillo2  , Javier Álvarez-Bermudes3  , Marco Vinicio Gómez-Meza4  , Nora Angélica Armendáriz-García1  , Eva Kerena Hernández Martínez5 

1Doctora en Ciencias de Enfermería. Facultad de Enfermería, Universidad Autónoma de Nuevo León. México.

2 Doctora en Filosofía en Psicología. Facultad de Enfermería, Universidad Autónoma de Nuevo León. México.

3 Doctor en Psicología Social. Facultad de Psicología, Universidad Autónoma de Nuevo León. México.

4 Doctor en Estadística. Facultad de Economía, Universidad Autónoma de Nuevo León. México.

5Maestra en Ciencias de Enfermería. Profesor Titular Facultad de Enfermería "Dr. Santiago Valdés Sánchez", Universidad Autónoma de Coahuila. México.


Spirituality is a concept that has been linked positively with physical and mental health of people and has been found to play an important role in the management and recovery of substance abuse like alcohol. The main objective of this study was to determine the spiritual perspective of the members of AA. The design was quantitative, descriptive cross-sectional. The population consisted of members of AA 3 suburban municipalities of Nuevo Leon, Mexico. A non-probability sampling was performed, the sample consisted of 35 adults from AA groups, Spiritual Perspective Scale (SPS) was used. The results show that the average rate of spirituality in the participants was 66.33 (SD = 17.23), the average spiritual practices was 59.64 (SD = 25.11) and spiritual belief was 70.70 (SD = 16.60). It is concluded that AA members have a high level of total spirituality, spiritual practices and spiritual beliefs.

Keywords: Spirituality; Alcoholics Anonymous; Alcoholism


Spirituality is a concept that has been positively related to the physical and mental health of people and has been observed to play an important role in the management and recovery of substance abuse such as alcohol1)(2

In the case of dependence on alcohol and alcoholism, spirituality represents a concept of great importance. Different studies indicate that spirituality can act as a protective factor of alcohol dependence, favors in the treatment of recovery, is related to long periods of abstinence and helps in the management of craving 1)(2)(3)(4)(5.

In Mexico, the National Addiction Survey (2011) reports that 6% of the population developed alcohol dependency, equivalent to 4.9 million people between 12 and 65 years of age, of whom 10.8% are men and 1.8% for women. Alcohol dependence affects 4.1% of adolescents and 6.6% of adults, this proportion increased significantly among men from 2008 to 2011, showing a lower distance between men and adolescent women (3 men for each woman) Than what is observed in adults (7 men per woman). The proportion of adult women with alcohol dependence is 1.7% similar to that observed in adolescent women (2%); in men, a teenager with this condition is presented for every two people with alcohol dependence6.

Currently, AA represents the most widespread therapeutic resource to treat alcoholism in Mexico and other countries without claiming to be the most effective. AA adherence or affiliation may be beneficial to people experiencing this problem and stands out as a construct that supports the AA recovery process attendance at meetings and the level of participation in AA groups and indicates that the greater the involvement With the twelve-step program the recovery prognosis is best4)(7)(8)(9.

Also, Alcoholics Anonymous (AA) and its 12-step program attaches great importance to the concept of spirituality. AA in its program assumes that alcoholism is a disease of the spirit that is why the 12 steps of AA are linked to spirituality and accentuate principles such as prayer, meditation and acceptance of a "God" so defined Personal or "Superior Power”2)(10)(11.

Spirituality has been defined by Reed as the personal perspective and the behaviors that express sense of belonging (relation) to a transcendent dimension or to something greater than itself. From this spiritual perspective, concepts such as "pray" and "Supreme Being" are significant for the construction of this construct. Specifically within the indicators of spirituality we can find prayer, meaning to life, reading and contemplation, sense of closeness to a Supreme Being, interaction with others and other experiences that may reflect spiritual interaction or participation1.

Studies carried out in AA indicate that spirituality is positively related to the percentage of days of abstinence, predicts non-consumption of alcohol, and that "spiritual awakening raises the probability of maintaining abstinence in AA2, Four.

However, in Mexico there are few studies conducted to know the level of spiritual perspective in this population. For nurses, it is extremely important to know those factors that favor abstinence in AA members for the development of interventions based on scientific evidence focused on the reinforcement of resources and skills that favor the non-consumption of alcohol in people dependent on Alcohol that are being treated. It should be noted that in our country we have not found studies performed by nursing professionals where this variable is addressed in AA population. Likewise, no studies have been found where the Spiritual Perspective Scale (SPS)1 is used in this population.

Therefore, the main objective of this work is to determine the spiritual perspective in AA members. A pilot study.

Specific objectives

  1. Determine the filling time of the Spiritual Perspective Scale (SPS) in AA members.

  2. Determine the Cronbach Alpha Reliability Coefficient of the Spiritual Perspective Scale (SPS) in AA members.

  3. Describe the frequencies and proportions of spiritual practices and beliefs according to the Spiritual Perspective Scale (SPS) in AA members.


Study design

The design was quantitative-descriptive. The population was made up of AA members from 3 suburban municipalities of Nuevo León, Mexico. A non-probabilistic sampling was performed, the sample consisted of 35 adults belonging to the AA groups.


Sociodemographic data. Personal Data Card (CDP) consisting of 8 questions that ask the sex, age, marital status, educational level, occupation, religion and age of admission to the AA program and the number of relapses.

Spirituality. The Spiritual Perspective Scale (SPS) 1, measures a knowledge of itself, a sense of connection with a being of a higher nature or the existence of a supreme purpose. The instrument is based on the conceptualization of spirituality as a particularly relevant human experience in the late stages of life development and at times where awareness of mortality is increased.

The scale consists of 10 statements that are graded in a range of 1 to 6 for a total score of 60. The first four questions correspond to the subscale of spiritual practices and respond with the following criteria: 1) Never, 2) Less than Once a year, 3) More or less once a year, 4) More or less once a month, 5) More or less once a week, and 6) More or less once a day. Questions 5 through 10 correspond to the subscale of spiritual beliefs and are answered as follows: 1) Extremely disagree, 2) Disagree, 3) Disagree rather than agreed, 4) Agree rather than disagree, 5) Agree and 6) Extremely agree.

Indexes were obtained from each subscale and from the scale in general, where the highest score is the spirituality index. In order to classify the level of spiritual perspective of the participants, the levels established by Vázquez12 were taken, which considers the following: low level of spirituality of 10-30 points, moderate level of 31-45 points, and high level of spirituality of 46-60 points.

The original scale reports Cronbach's Alpha of .90, a study done in the Latin population, 13 the scale reported a Cronbach Alpha of .89.

Procedure for collecting information

To begin with the implementation of this study, approval was obtained from the Ethics Committees for Research and Research at the Faculty of Nursing of the Autonomous University of Nuevo León (FAEN-D-1182).

Three AA centers were requested to request authorization from each group and its members, the purpose of the study was explained to them and those who agreed to participate were given informed consent. Subsequently, they were given a sealed envelope with the instruments and filled out the questionnaires, reinforcing the confidentiality and anonymity of the information. Finally, they were asked, at the end of the filling, to deposit the sealed envelope without identification in a sealed box that was in the front of the physical space where each group meets. When depositing the envelope with the instruments, they were thanked for the time and information provided.

Analysis of data

It was performed through the SPSS statistical package for social sciences version 20. Descriptive statistics were used. The descriptive analysis of the continuous and categorical variables was performed using frequencies, proportions and measures of central tendency and variability. In addition, the reliability of the instrument was determined through Cronbach's Alpha.


Regarding socio-demographic data, the mean age of the participants was 51.03 (SD = 13.82) years of age, the majority were male in 97.1% (34), 37.1% were single, 31.4% had attended to primary level, the majority work (62.9%) and the Catholic religion predominated in 68.6%. Regarding the age of admission to AA, the average was 35.06 years (SD = 9.81) and mean relapse was 4.17 (SD = 10.08).

The instrument filling time was 30 minutes including CDP. Cronbach's Alpha of the Spiritual Perspective Scale (SPS) for this study was .90.

The 37.1% (13) of the participants reported mentioning spiritual matters when they are talking to their family or friends about once a month, 37.1% (13) mentioned that more or less once a day you share with others the problems And joys of living in accordance with their spiritual beliefs, 40.0% (14) reads spiritual materials about once a day and 60.0% pray in private or do meditation more or less once a day (Table 1).

Table 1 Frequencies and Proportions of Spiritual Practices 

Note: 1 = Never, 2 = Less than once a year, 3 = More or less once a year, 4 = More or less once a month, 5 = More or less once a week, 6 = More o Less once a day, f = frequency, % = proportions.

The 51.4% (18) of the participants agree that forgiveness is an important part of their spirituality, 45.7% (16) agrees to see spirituality as a guide to making decisions in their daily lives, 51.4% % (18) strongly agrees that their spiritual beliefs are an important part of their life, 57.1% strongly agree that they often feel very close to God, or to a "greater power" at important moments in their life. Daily life, 54.3% (19) strongly agree that their spiritual beliefs have influenced their lives and 51.4% (18) strongly agree that their spiritual beliefs are especially important because they answer many of the questions they have about the meaning of life (Table 2).

Table 2 Frequencies and Proportions of Spiritual Beliefs 

Note: 1 = Extremely Disagree, 2 = Disagree, 3 = Disagree more than in agreement, 4 = Agree rather than disagree, 5 = Agree, 6 = Extremely agree, f = Frequency, % = Proportions.

The index of spirituality in the participants presented an average of 66.33 (SD = 17.23), the average of spiritual practices was 59.64 (SD = 25.11) and the spiritual beliefs were 70.70 (SD = 16.60) which are considered as a High level of spirituality (12) (Table 3).

Table 3 Index of spirituality 

n X Mdn SD
Total spirituality index 35 66.33 70.00 17.23
Index of spiritual practices 35 59.64 66.67 25.11
Index of spiritual beliefs 35 70.79 72.22 16.60

Note: n = sample, 𝑋 = mean, Mdn = median SD = standard deviation


The main objective of this study was to determine the spiritual perspective in AA members, it was found that members of AA have a high spiritual outlook. This coincides with that reported by Kelly2 who mentions that people who attend AA have a high level of spirituality. It is possible that spiritual level in the participants present a level because the program of step 12 of AA is based mainly on the conception of a "Supreme Being" and promotes spirituality in 11 of its steps.

The program leads the person dependent on alcohol (alcoholic) to admit their impotence against alcohol through the help of a higher power conceived individually and privately (1 to 3 Steps). Subsequently, an examination of conscience and a moral inventory are promoted, with the intention of repairing damages caused to third parties during the alcoholic stage (4 to 9 Steps). Then emphasis is placed on the continuity of self-observation, the permanent correction of errors and the spiritual dimension (10 to 11 steps). Finally (step 12) promotes helping other alcoholics or alcohol dependents to achieve sobriety14.

Because this is a pilot study, one of the objectives was to determine the time of filling of SPS in AA members, it was observed that the participants took approximately to answer the instrument along with the CDP, this is similar to the one reported by Galvin And Pérez15 in her study of women with cancer. It is important to note that to date no studies have been located where SPS is used in AA population, because of this it was necessary to know SPS Reliability in AA members.

The SPS showed a Cronbach Alpha of .90 which is considered acceptable and coincides with that reported by the author of this scale1 and higher than reported in other populations15.


The filling time of the instrument was thirty minutes.

The Spiritual Perspective Scale (SPS) reported for this study a Cronbach Alpha of .90.

High levels of spirituality perspective were reported on the full scale as well as on the subscale of spiritual practices and beliefs.


It is recommended to carry out a validation of the SPS in AA population, and also to continue to use this instrument in AA members for future research and to conduct studies where this variable is related to alcohol consumption, withdrawal time and the number of relapses in Members of AA.


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2. Kelly JF, Stout RL, Magill M, Tonigan JS, Pagona ME. Spirituality in Recovery: A Lagged Mediational Analysis of Alcoholics Anonymous Principal Theoretical Mechanism of Behavior Change. Alcoholism Clinical and Experimental Research. 2011; 35(3): 454-463. ]

3. Robinson, E.A., Krentzman, A.R., Webb, J.R. & Brower, K.J. Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes an nine months. Journal of Studies on Alcohol and Drugs 2011, 72(4), 660-668. ]

4. Gutiérrez RR, Andrade PP, Jiménez TA, Saldivar HG, Juárez GF. Alcohólicos Anónimos: Aspectos relacionados con la adherencia (afiliación) y diferencias entre recaídas y no recaídas. Salud Mental. 2009; 32 (5): 427-433. ]

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8. Rosovsky H. Alcohólicos Anónimos. En: Beber de tierra generosa. Ciencias de las bebidas alcohólicas en México. Fundación de Investigaciones Sociales AC (eds); México: 1998. [ Links ]

9. Rosovsky H, Leyva G. Movimiento de alcohólicos anónimos en México. Anales 1990; (1): 5-8. [ Links ]

10. Alcoholics Anonymous. Twelve steps and twelve traditions. Alcoholics Anonymous World Services; New York: 1952. [ Links ]

11. Alcoholics Anonymous. Alcoholics Anonymous: The story of how thousands of men and women have recovered from alcoholism. Alcoholics Anonymous World Services; New York: 2001. [ Links ]

12. Vázquez O, Whetsell M, Zavala MR. Bienestar espiritual y ansiedad en pacientes diabéticos. Aquichán 2006; 6 (1): 8-21. ]

13. Campesino M, Belyea M, Schwartz G. Spirituality and cultural identification among latino and non-latino college students. Hispanic Health Care International. 2009; 7 (2): 1-13. ]

14. Alcoholics Anonymous. 2011 Membership Survey. Alcoholics Anonymous World Services; New York: 2012. [ Links ]

15. Galvis LMA, Pérez GB. Perspectiva espiritual de la mujer con cáncer. Aquichán. 2011; 11 (3): 256-273. ]

Received: June 10, 2016; Accepted: August 30, 2016

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