AA Members Understandings of the Higher Power (HP) A Qualitative Study

Thematic analysis (TA) was used to research how AA members understood the Higher Power (HP). The question of its place in recovery from alcoholism was addressed. The analysis of 10 recorded one-hour interviews led to argue that the Higher Power is not only central to sobriety by also to the well-being of AA members whatever their original or current declared spiritual or religious beliefs may be. Their experiential relationship with it gives a new meaning to their life which goes beyond their sense of identity. The centrality of the HP in AA seems to rub off on its members so that by practicing the program they act more and more like believers in their lives. The main understanding of the HP is Love.

The Twelve-Step Program is "a program… designed especially to help an individual overcome an addiction… by adherence to 12 tenets emphasizing personal growth and dependence on a higher spiritual being" [16].
Prayer has had many different definitions. A simple one is "Prayer is, at root, simply paying attention to God" [17].

Literature review
AA literature: Because the illness of alcohol dependence is said to involve all aspects of the person, physical sobriety is only the surface goal of the program. The Alcoholics Anonymous book states that drinking is just symptom of a malady in a physically, mentally and spiritually sick person, "the body of the alcoholic is quite as abnormal as his mind" [18].
Sobriety is referred to as a "gift" received in consequence of "working the program". Further along comes more: "The short-term goals are to attain and maintain sobriety. The long term goals are to live a life of joy and happiness, of purpose and meaning". That is a tall order, way beyond what the non-alcoholic general population envisions. AA might have discovered, or reframed, some laws that everyone could benefit from.
Many references to God are found in the AA Big Book as well as in the 'Twelve Steps and Twelve Traditions', aka '12 & 12' AA book. Those books present an expectation that the more AA members mature, the more spiritual they will be. "When we developed still more, we discovered the best possible source of emotional stability to be God Himself." [19].
The Big Book does not try to avoid the subject with atheists and agnostics: "if an alcoholic failed to perfect… his spiritual life…, he could not survive" [19]. An entire chapter, "We Agnostics" (2001, Chapter 4), is devoted to them. It concludes that a change of ideas is necessary. "Our ideas did not work. But the God idea did" (p.52), fitting well with Jung's suggestion that if medicine did not work for Hazard, God might. Though gentle in its approach, that AA chapter does not mince its words, "Our human resources… failed utterly. Lack of power was our dilemma. We had to find a power by which we could live, and it had to be a Power greater than ourselves." (p. 45) The expression Higher Power, first coined by Alcoholics Anonymous, was subsequently taken on by all other twelve-step programs that followed, simply defined as "a power greater than ourselves" (Step 2), opening the door to those who have no religious or spiritual beliefs. New members are encouraged to see the HP as any power that they choose to consider as higher than themselves. Various concepts are adopted by people. However, a criterion often referred to as essential to a HP in the 12 steps program, which is being loving and caring, does not apply to all concepts. For example the Universe chosen by some as a HP does not include love and care.
One reason found in the Big Book for the centrality of the HP in AA is that Alcoholics are an extreme example of "self run riot", being their own God. Directing their own lives leads them to "insanity", hence the need to find another guide in life, another God than self.
Academic research: There are currently two academic definitions of AA: a religious sect (with all the negative implications of the term) and a voluntary self-help organization. The qualification of religious sect coming from a materialistic world view has resulted in skewed interpretations. "Current AA researchers… whose secular framework cannot easily accommodate non-scientific paradigms often parody, trivialize, or stigmatize AA" [6]. Having considered both perspectives, Borkman concluded that, "The voluntary association fits best with and is informed by the research on self-help/mutual aid" (2008 p. 12).
Within that perspective, AA is unique [6]. Its original qualities include: sometimes mandated (as alternative to jail or to losing job); sometimes strongly rejected for its spirituality; strong influence on all other areas of addiction recovery (overeating, sex, etc.); unprecedented impact on addiction treatment; apparent paradox within: "shared vulnerability, not shared strength, binds members together, and is believed by some to be the key to recovery in AA" [20,21]. Importantly, AA is the only organization that offers a free follow-up for life to its members; no other treatment organization, whether private or governmental, can afford to give such continuous support [22]. Finally, researchers agree about the importance of "contact with God, humility, prayer and meditation; taking personal inventory or serving others" [20,2].
The importance attributed to the HP is seen by some as the main reasons why "AA has been much more effective than psychiatry in treating alcoholics… because… AA addresses the spiritual needs of these people -something that traditional psychotherapy, with its secular humanist values, does not address" [23].
So how atheist or agnostic AA members become sober by adhering to that program can be perplexing, but generally recovery means more for AA members than sobriety, which is the main aim of addiction treatments. Lasting sobriety might depend on another goal, possibly linked to spirituality or a Higher Power. If that was the case, treatment aiming only at sobriety would be missing the main point.
What does Higher Power mean to AA members?

Methodology
In research about addictive behaviours, qualitative methods have been used as pilots or parallel with quantitative ones, such as in Akhtar and Boniwell's research on alcohol-misusing adolescents (2010) [24].
Seeking here to explore new territory, a qualitative method has been chosen, using Thematic Analysis to make sense of the data.

Design
The kept interviews of 10 AA members' were conducted and audio recorded in semi-structured fashion, as non-directive as possible, following the interviewees' leadings. Transcribed interviews were analysed for meaning, themes, subthemes and categories extracted from the data collected.

Materials
A Briefing Sheet explained to the interviewees what their participation meant including confidentiality, use of information given, transcription and anonymisation, plus any possible disadvantages that could occur. After briefing, interviewees signed a Consent Form.
A list of questions was drawn with objectives in mind: what were participants' understandings of a Higher Power (HP); what it meant for them personally; how it translated in their everyday experiencing, with prompts about relationships, work, feelings, and health; how they thought it affected their recovery; what had been their understanding of a HP before coming into AA; how it had changed during their time in AA; how it compared with others in AA; finally did they want to add anything.
A Debriefing Sheet asked about how the participants perceived and felt about the interview.

Participants
A criterion of two years minimum in AA was chosen to insure participants had time to seriously consider the concept of HP. This concept is original to 12 Steps programs. It was assumed (and perhaps this assumption introduced a certain bias) that it takes time for new members to get to understand it and to decide how they can personally interpret it, hence the choice of 2 years membership minimum criterion. It was somewhat confirmed in that although one participant mentioned having heard people talk about far-out choices such as a cartoon character or random celebrities (see p. [13][14], all interviewees seemed to have seriously considered the question after a while in AA. 12 persons were originally interviewed. Two were eliminated, one was used as a pilot and the other turning out to be a new AA member, was not analysed. 10 interviews were analysed, of six men and four women. Participants were a mixture of British (majority), Irish, Polish, South African Iranian-Pakistani, and other mixed race origins. Their ages ranged from early thirties to early sixties. One was unemployed; others were in manual, liberal or business professions. They classified themselves from atheist to religious. Six persons talked about their coaddictions, five to drugs, alcohol being their drug of choice except for one, who considered alcohol as one among his drugs (co-addiction to drugs seemed common in today's AA population). One person had some behaviour addictions. Three presented themselves as exclusively addicted to alcohol.

Procedure
Participants volunteered from four open meetings. Most interviews were conducted in a Quaker house library room. Two interviews were conducted in a participant's house as they had a little child they couldn't leave.

Interviewees' comments:
All the interviewees but one said they had enjoyed the interview. Three commented that it had been very useful for them to examine where they were at. One person said, "It's like counselling, only better because I could talk about the Higher Power freely." Another said, "It gave me some clarity, I see better what I will need to do."

Analysis
Contrasting with the phenomenological approach, which goes from descriptive to interpretative, the realist approach assumes there is a reality to be found; from another perspective, a naïve approach takes the data literally as opposed to a critical approach, which perceives deeper forces involved [25]. After a title/code was given to each idea in the transcript of the interviews, the data did not always seem to directly reflect reality, due particularly to the ambivalence manifest in some discourses. Therefore a mixture of naïve and critical realist approach was taken. The codes examined separated from the data, similarities searched, rough categories were noted. Though not all fitted into categories, no codes were left out as secondary ones could turn out to be important later on. "As the frequency of the appearance of a code does not in itself determine its significance, the researcher's decision about what is and what is not important can evolve throughout the analysis." [25].
"Deduction begins with an expected pattern that is tested against observations, whereas induction begins with observations and seeks to find a pattern within them" [26]. A deductive approach was taken first, looking into research articles about AA and in the AA steps. Then, from the data itself, new ideas of possible themes came, in an inductive process. All names were changed to respect confidentiality.

Findings
Three main themes were extracted from the data: 1. Understanding of Higher Power. 2. Communication with Higher Power. 3. Impact of Higher Power.
Theme 1: Understanding of HP: Two main criteria were noted. One, close to HP definition: "Greater than self", was noted by five interviewees, one of them Annie: "I found it quite easy in my early days to conceive it as the power of the group or the power of the principles behind AA, kind of AA in theory, taking out the personalities. … That fulfils a number of criteria, and actually I suppose it fulfils the HP criteria which is a power greater than you." The other main criterion, adding further understanding, was described as Benevolence.
Care and Protection were also often cited as requirements for a HP.

Subthemes
Three main subthemes were extracted: Power of Meetings (HP commonly suggested to newcomers); Love; and Other Ideas.

Power of Meetings includes categories of Listening and Social Aspect.
Love includes categories of Energy, Force, or Power; Moving and Changing; Qualities; Universal laws; "Something"; Human Expression and Central to AA.

Other Ideas includes Freedom of Choice, Questions and Negative Perceptions.
Power of the Meetings (also called "Rooms"): chosen by some as their unique HP: "My HP then became the group, to put my faith and my belief… in the support of the group" (Annie) Moreover, whatever their understanding of the HP, most participants talk about the power they feel in the meetings and how it rubs on people.
"I do go to AA meetings because they're very pure places to practice the HP" (Dom) "And every time I went to the group I felt something there, a strong feeling…" (Carl) "So it rubs off, their HP in the room or their confidence to talk about it will be heard by someone on their first day or their first year: if he can do it, I can do it." (Fred) "It was almost like a form of osmosis… going to meetings, and the longer you go, then you just absorb it… that's what happened… how I felt it." (Gabe) "I sought out a well-known atheist and asked him for his point of view. He was a big believer in going to meetings, just do lots of meetings and that will keep you sober." (John) "Who knows which part of an AA meeting that works? And yes, there is this power that keeps us sober, and I couldn't stay sober by myself. So I know it's there." (Alex) In Listening, others stories and identifying with what they say had a profound effect on most. Participants talked about feeling accepted in meetings. Stories of survival are linked to the HP.
"it helps as well… when I go to meetings and I hear other people sharing and what they're going through is terrible, it's death and… when I hear them kind of saying that they know they're gonna be ok, and that's how strong their faith is, in whatever it's in but that's how strong it is, that makes me feel better, that makes me feel whatever is going on in my life, which is minor in comparison, I can deal with that…" (Emma) "I felt like, oh, there's hope! These people are like me! I thought I was an alien… we'd read some preambles and then people say their names and say they're addicts and then… it just hit me… I've got to cry with trembling to say my name and say I'm an addict and just pow, just pick the lid off this pressure-cooker… it's like I've arrived, at last… Then but I knew, they start to read the readings and I thought oh my God, I've got to be here! This is where I belong because who's written this stuff? Someone's inside my head! Someone is… gone inside and photocopied my brain… and vocalised it (laughs)! That's what I think, that's what I've done! And then it was that identification…" (Carl) "I guess that's another aspect of how the rooms work… because ultimately we're all in the rooms because we're flawed, we're all in the rooms, we've all done bad things and we've all done, and… that… does level pride, that does make us all of the same level." (Emma) "I've done well in the last few years because I've been open and I've been listening to others that have been through it." (Fred) "You can almost gage people's level of contentment… from their degree of contact with their HP…" (Grant) "there are meetings for agnostics and atheists and I've been to a couple just kind of… 'cause… if I'm in an area and there's a meeting on, I'll go to it, it doesn't matter if it is gay-lesbian or if it's agnostic-atheists… and nobody ever turns around and says, but... you're not that… you know, it's just done respectfully. People are respectful of others so I go to meetings for agnostics-atheists or gay-lesbians if I'm in the area of one, and no one will ask whether I belong." (Emma) "Actually you can hear someone who's got a perfectly ordinary story and you can see how things were hard for them too, so that was kind of opening my eyes about being that selfish." (John) 'Rooms' (meetings) were compared to a non-directive therapist.
"My therapist never really… pushes on me… it's always been directed by me, so… she's helped me along the journey without leading me… and… that's just what I hear people in the rooms…" (Emma) The Social Aspect of Meetings was noted by the majority of participants: "I need to go. But actually, although I need to go, I like going. So, yea if somebody said to me oh you don't need to go any more; I would be devastated (laughs). I like the people." (Alex) "You get a feeling that you're in the right place and that you're not alone, so that can be very powerful for people who have been isolated for a long time, just being in a group of people could be so, it can be amazing…" (Fred) "The HP and the rooms cared for me" (John) "if you talk about these things, get it in the open, it's not secret. It's not an evil little secret that you will manifest. It'll manifest and rot, you know, it'll get worse and worse, so you talk about it and get it out there, bore everyone stupid with the same thing. But if it stops you drinking for that day, it works. So yes, it does work." (Fred) Carl felt others' emotions in meetings: "I used to think well all these, these upset children came as adults, but we're still children you know and so all that made me feel… that for me was all very spiritual, very spiritual. I felt a deep connection and where I'd never felt connected…" Two persons mentioned attending meetings also to find people to help: "It's very active, my illness… so I have to be on top of the meetings and helping others, helping other alcoholics who do help." (Fred) "The other thing is that it's only by going to meetings that you can get the opportunity to help other people." (Alex) They both believed that skipping meetings would probably cause relapse, so fear of a bad ending is a motive to go to meetings.
Dom described why Meetings worked, but believed, like Emma, that they could vary: "How come they work so well? ...I believe it's 'cause you put your differences aside and you just go for the common good... the idea is… just very nice, you say like thank, you say hello to everybody… everyone is given a chance to share… you all do service together and even if some patience's needed… some for half an hour and you shouldn't really give any criticism afterwards and… there might be a few meetings where I think it goes a little bit off because… you might have heard of meetings where they're very rigid in terms of you have to do this, you have to do that, you have to call two people a day… I think it's like a church you get very evangelical churches and then churches very liberal…" "I wouldn't go back to meetings with old-fashioned ideas about God, God-heavy or aggressive meetings like I've heard of… I've heard of fanatical meetings I would leave. I choose which meetings to attend". (Emma) Love was cited by most in its name form or as a quality of the HP.
"As an adult in AA, in a recovery program, God is all loving and all compassion and healing… There's just love really, and I think for most of us that would be the same, certainly the people I know in AA." (Liz) "I came through that experience with a stronger, with a deep connection to my understanding of what that power is, who what my God is, and He's unconditional love. It's given me an ability to love… and to like myself, which I didn't, couldn't do. I didn't know how to, I didn't know… how to do love, because I didn't have the ability to love myself. So… because my HP loves me unconditionally, I've learned to love myself. I know there's something out there loving me, unconditional, no matter what I do, that this thing is gonna love me, you know. And… that's where you know where my recovery's been shifted and then if people tell me, what is your HP? I say, its love, its unconditional love. I'm loved, you know, I'm enough, I'm ok." (Carl) Hum, you know what it says in the literature: the important thing is that you know it's not you. And one of the things I like about AA is that you don't need to define it or understand it, you just have to believe it. It's good to not have to define it… I observed that with time, AA people seem to need less and less to understand God." (Alex) Liz accepted it even when she forgot it: "It's there, and I know enough about it now. It's 'Progress not perfection' 1 , so…" The Higher Power is described by four persons as a category of Energy, Force or Power, which they cannot control: "That has effect, it's real… I can't control it… I can try and access it… decide to act in line with it." (Lily) "… My HP is… a life-force, a benevolent, kind, embracing, comforting life-force. And I believe that it emanates from out there... It's somewhere out there in the great unknown… an unseen force. But there's absolutely no doubt that it's nice… A common view of the HP among religions is that it is otherworldly, to be reached for… Seeking the HP can be scary as one can realise more of its power." (Gabe) The category of Moving, changing relates to participants' views of the HP. When Carl needed help from the HP, his connection with the HP was made clearer.
"My understanding of the HP is quite new… it evolved… my understanding… So this is something that's quite new for me… I knew that my HP was looking after me and… I wasn't on my own, and that things were gonna be alright, and it's gonna be tough but it's gonna be ok. And that's what I call faith. But that didn't come easy; it's work, a long road to get to that faith. I couldn't just switch that faith on. I didn't even know what it was, what it felt like. I don't think I ever had faith in my life that things were gonna be alright, that it's all gonna be ok, that I'm loved, you know." The category of Qualities also includes Loving; Very loving; Unconditionally loving; Caring; Good; Benevolent; Comforting; Kind; Forgiving; Non-judgemental; Accessible; Powerful; Very powerful; Knowing everything; Personal; Complex; Extraordinary; Teaching; Non-directive.
"maybe it helps with forgiveness as well… just kind of having a HP that is forgiving, I don't know just maybe in a weird way it helps me be more forgiving… the unconditional part is very important" (Emma) "God in AA is all loving, compassion and healing." (Liz) "It's accessible. And it's so powerful and it's so all-knowing that the billions of entities that are trying to access that or are trying to shy away from it, its response is… individualistic and tailored to that particular being's needs" (Gabe) "The HP in AA is not like in religions but is individual". (Emma) "I think instead of it being the unifying thing, where it might be in a church or synagogue… it's a very personal thing." (Liz) "Given a choice, alcoholics accept a HP as long as it is benevolent" (Gabe) "The extraordinary is commented as HP… if something… extraordinary happens, we will say, 'HP! HP!'" (Liz) "Embracing, comforting… the HP is teaching me. The longer I don't put any addictive substances in my system, the more He will reward me with brain power and with… vision, an inner vision. " (Gabe) Three participants mentioned Universal laws, such as the Universal law of retribution: "As I help someone, the HP helps me." (Emma) "It's universal… if you apply AA procedures to most things…" (Fred) "…there are probably universal laws linking working the steps with the promises… Lois 2 observed the law that you have to give in order to keep… If one does the right things, finances will be ok." (Alex) An interesting sub-theme is that of "Something", which interviewees mentioned when they told of HP interventions, signs or being looked after: "Something got me to meetings in my first two years…" (Emma) "Something was looking after me… keeping me safe in my drinking days… To have drunk as I did and be safe was a mystery… Something kept protecting me and giving me another chance." (Annie) Three persons mentioned the need for a Human expression. One thought Jesus was a communication tool to get out an altruistic message, a miracle man as bait for religion. Jesus was someone else's Higher Power. Power, who he sometimes calls God. Three participants shared such ambivalence, identifying as atheists yet praying and acknowledging some difficulty in understanding the concept of Higher Power. John regularly prayed step 11 3 and step 3 4 prayers, believing that it reinforced sobriety.
"I'd say the step 3 prayer… 'God, I offer myself to Thee… Take away my difficulties, that victory over them may bear witness to those I would help of… Thy Love, and The Way of life.' That makes it quite difficult: you have to then start thinking, but what is 'Thy Way of life'? What does that mean?" In AA, prayer's simplest typical form consists in asking for a clean day in the morning and thanking for a clean day in the evening, which those interviewees reported doing.
Prayer also includes a subcategory of Set Prayers such as the Serenity Prayer or Francis of Assisi's prayer. They are carried out in meetings or privately. Fred prayed the Lord's Prayer (New Testament, Matthew 6: 9-13): "Without failure I do say the Lord's prayer because… it calms me down".
John mentioned Francis of Assisi's prayer [19]: "Someone shared at the… meeting… that the step 11 prayer was God's way of life, the Francis of Assisi Prayer, and actually as a set of goals that's pretty good." Other times those prayers were used as needed: Alex applied the Serenity Prayer [19] to things he could change and things he couldn't in order to find the things he could work on and the things he couldn't. Another form of prayer -to find and do God's will -is the second part of Step 11: "... praying only for knowledge of His will for us and the power to carry that out".
Morning prayers were important to the interviewees, setting the tone for the day, even though two said they did not know what they were praying to.
"People have gone out after 25 years, 40 years… probably they stopped praying". (Fred) "If I don't pray in the morning or meditate, my day will not go right. If I do, even if there are problems, it will be ok". (Dom) Another form of prayer consists in Asking for needs: "Sometimes I suffer from nightmares, violent, really nasty...: 'Please take this away! I can't handle this!' -gone!" (Fred) Emma prays, but not to ask for things: "I'm careful not to pray for stuff because that's taking back my selfwill. And my self-will doesn't get me anywhere basically… I don't pray for things to get better but I pray for me to get through something… I pray… 'O let me do the best I can… just be with me, give me guidance'… I have 10 little marbles and in the morning I put them out, one for each thing I'm worried about, I hand that over, and then the same marbles at the end of the day are for the things that I'm grateful for. So I'm starting my day by handing over things to God that I am scared of, and I'm finishing it by the things that I'm thankful for." 'Keep it simple' is one of the AA slogans which she likes to apply to prayer, along with three other interviewees. She contrasts it with prayers from her Catholic background: "Sometimes, I struggle with the prayers because again of my that." (Annie) "I struggle with spirituality… not really knowing what it means. I was on a dating site years ago and one of the categories they have is spiritual but not religious… does that mean you believe in a God but not a particular God?" (John) The word "understood" in the "God as we understood him" of Step Three was interpreted by them as having to understand before believing. All participants had had Questions about the HP; five in particular were reasoning a lot about it: "It could be anything. I don't really particularly have a concept of what a HP is… it's nothing concrete… for me it has no image, it's… certainly not visible… it's just… because I can't come up with a mathematical formula that would say, A= B therefore C must be the HP." (Annie) "After my last relapse, I had a fairly serious thought… when I was in kind of alcohol withdrawal afterwards so my head was a bit messy, but I thought: is this because I don't believe in God? Do I need to believe in God in order to be able to stay sober?" (John) Lily struggled with it differently. Not doubting the HP's existence, she wondered how she could build a relationship with it. Like all communications, it goes two ways: Speaking (including asking) and Hearing (including receiving), two main subthemes.
Speaking includes categories of Prayer, Handing Over, Expressions of Gratitude, and Connecting.
Hearing includes the categories of Listening, Interventions, Coincidences, and Being Looked After.
Speaking takes primarily the form of the category of Prayer, cited by all interviewees. Fred marvels at the fact that "I know a lot of atheists that pray… and they get on their knees in the morning!" He vacillates between adoration and rejection of the Higher 3 Step 11 prayer: "asking each morning in meditation that our Creator show us the way of patience, tolerance, kindliness and love" (AA, 2001, p. 83). 4 Step 3 prayer: "God, I offer myself to Thee -to build with me and to do with me as Thou wilt. Relieve me of the bondage of self, that I may better do Thy will. Take away my difficulties, that victory over them may bear witness to those I would help Three participants reported that in desperate times simple prayers were insufficient. Carl, distraught, went through a time of intense prayer that led him to a shift in his relationship with the HP, making it more real, intense and satisfying: "…not knowing whether I was gonna see her again. And then I was distraught... But then I had to pray and meditate, pray and meditate. And it… then you know through whatever happened… So it all made clearly this connection with my HP bigger." Lily described feeling like a spectator to prayer, observing people in meetings, and reading about it. She wanted to learn more about it and tried to reason her way into a closer relationship with the Higher Power.
"I know people that feel held. They've got a sort of personal God, a personal HP, say they feel loved by their HP. These people talk about their strong connection; and I'm thinking: I know I've healed. I've got my tools, but they've got this relationship! What's that? I need to work a bit on my prayer... I just have to accept I don't have that, and I'd have to work for it. Why do people pray to something? Is it within or without, or both? A relationship meaning an exchange, I need a figure or an object to relate to it… The program encourages having a relationship with the HP; I'm trying to: if you say the HP is love… how do you build a relationship with something that is so vague?" Well practiced in meditation and used to Buddhist meditation retreats, she observed: "The Buddhist says there is no God but then the next minute they're all praying to some manifestation -one of their beings -for protection, to be well. So that's prayer! Though some Buddhists don't recognise that they pray, their asking for happiness, protection, etc., is actually a form of prayer. Some Buddhists don't like to say that they pray but to me when everyone says the same phrase together and asking for something: 'May I be well, may I be happy, may I be free from suffering and may I make progress', this is what you're desiring…" Though she likes meditation, she cannot adhere completely to the Buddhist faith which she sees as inconsistent: it does not include God, yet involves making requests, which she understands as actual prayers.
In summary, different types of prayers have been cited: from the simplest, morning asking for a clean day and evening thanking for it; praying set prayers alone or in group; prayer to find and carry out God's will (Step 11); praying for needs; and intense, desperate prayer.
The category of Handing over of concerns, cares and problems to the Higher Power, a practice derived from the Biblical injunction of "Casting all your care" [27], is referred to by six participants in response to life's problems. It can be seen as a form of communication since it involves telling -and giving -one's problems to a Higher Power. It even partially fits in with the concept of the AA group seen as Higher Power, the sharing of one's problems filling the telling part of the handing over.
"Literally some days I would be there like, hands out, be like just… I hand it over, just turn it over to you, whatever you decide.' And that helps!" (Emma).
She remembers to hand a difficult situation over: "It's quite unsettling… I woke up this morning, immediately, 'Hand it over, hand it over!' It'll be ok." Liz reported that she was able to hand over big things and bad events to God and trust, more than daily life situations.
Alex, who has been suffering from seasonal depression in the past, believes that he needs another strategy than handing over to deal with it: "For the first time I've got a sort of anti-depression plan… perhaps if I had more faith I could hand it over to my HP. That's difficult…" The category of Expression of Gratitude is a form of communication with the HP often referred to. Sponsors advise to do a nightly gratitude list for the past day. Dom, John and Gabe mention it.
The most obvious gratitude usually listed is for a sober day, as an interviewee notes. Giving thanks can be a problem for atheists or agnostics, but Fred finds his own strategy for it: "There is a need to be grateful for sanity when you become sober after years of drinking… You could go around and thank everybody… and they would look at you like an idiot. So if you can thank God, like in the Serenity Prayer, that's a gentle way to accept it." Here set prayer and gratitude are linked. Fred also showed gratitude by saying that finding AA is a privilege. He noticed that gratitude had a positive effect on him.
"I do that 'cause it calms me down… I just say thank you for a sober day…" John said: "one of the things that I try and do is a gratitude list which I share with other people, and certainly from a mental health kind of perspective I was not grateful for anything at the end of my drinking, now I'm grateful for everything really." Carl remarked: "Remembering the past gives me overwhelming gratitude to the HP for the present… I am grateful for the HP's protection from negative thinking, which is part of the addictive disease".
Liz said she appreciated being alive and feeling. She thanked God for better relationships. Now she felt blessed for having and trusting a HP, and for a normal life.

"I was in bed the other night saying to my husband, 'I've become the person with fitted wardrobes'… And it feels good!"
Gratitude is reported by four participants as also helping to make a Connection with the HP, a category cited by six interviewees. Carl said he got connected with the HP when he felt grateful for the sea, the mountains, or while running. Nature reminded him of when he experienced a shift from agnosticism to faith in God. Talking about it touches him to the point of tears during the interview.
Gabe links his present peace to his contact with the HP: "I couldn't have enjoyed present peace without improvement in contact with HP".
Along with two others, he believes that it also takes working at: "HP connection varies. Contact with the HP has to be constantly worked at. The HP is a force that we can access. It can be found by seeking it with altruistic intentions, through kind and altruistic thought processes and practices, and can be transmitted through altruism. It is accessible by being altruistic. Thoughts are not enough to access it. Challenging self or helping others is necessary at times." He felt he needed to acknowledge and make connection with his HP, 'a benevolent force', every morning, to protect him from making wrong choices later and self-gratify; choosing to have fun or indulge would have financial or emotional cost. He told his HP his objectives for the day and, willing to be guided differently to his plan, asked if his HP's will was different to his and who He wanted him to help.
Liz felt more connected with the HP and with the universe. Things seemed to have more purpose for her than before AA.
"I didn't feel a connection… not just with the church but with anything I was turning to: it didn't seem authentic." Emma felt a connection when handing over her will to the HP and believing that things would get better.
Annie and Emma got connected by reading "Promise of a New Day" [28]  "I read the Daily Reflections every morning and… I feel like it gives me connection with my HP and how I'm gonna live my day and I pray every morning, just, 'God, work through me, let me do Your will, not mine.' And that helps a lot!" (Emma) John, who called himself an "atheist", observed: "You can almost gage people's level of contentment -although external level of contentment anyway -from their degree of contact with their HP. Those people who maintain a constant dialogue with their HP -whatever that is -seem to be happier than the people who struggle with it. The problem that causes me is that intellectually I struggle with it… I try not to let it worry me too much!" Lily mentioned hearing people talk about that contact. The realisation that while busy with meditation she neglected prayer made her want to learn about it.
"I have progressed emotionally by using the program tools but I hear people with a strong connection with the HP and I wonder about it. I wonder how I can converse with what I find abstract like love or goodness. I read about emotional connection in rituals and thought I needed an object to connect to. So I started some rituals to connect with the HP, physically bowing, kneeling..." One way or another, no one in AA can ignore that contact with a HP. Most interviewees talk about feeling it in meetings.
On the other side of Speaking (Praying, Handing Over, Expressing Gratitude and Getting a Connection) is Hearing, interviewees talking about hearing from the HP.
Within it is the category of Listening. Emma said she got "…on the right track by listening".
Fred mentioned a less direct way he listened and heard. He relates how he interpreted a serious physical health problem.
"… I was diagnosed with diabetes type 1 a couple years ago, but I was thinking: 'Right, yea, this is God telling me to slow down!' Because I was a mad man, doing all this work everywhere. But this is turning the negative into positive!" Concerning his daily life, he says the HP is helping him along, slowing him down and commenting on decisions, telling him when it is appropriate to apologise, keeping him in check. He perceives the HP's presence as necessary for sobriety. He believes that not craving when he has a bad day is proof of the presence of the HP, without which he would drink.
Gabe said he received the message from the HP to choose life over drink and death. To him it meant pursuing the good.
The category of HP Interventions is reported by most interviewees.
Alex talks about that foremost intervention in the creation of AA itself, which two drunks could never have wrought by themselves, "I don't think a couple of guys could do that, a couple of random drinkers. The chances that they would sit down in 1935 and come up with a solution to a problem that nobody had been able to solve for 1,000's of years, and that it would be perfect, the odds of that, just it's not plausible. So there must be a power greater than them." He believes he is alive because of the HP's intervention since "…stopping drinking was the last thing I was gonna do." Fred's observations of nature make him doubt his atheism: "I work with nature and the things that I notice… It's spectacular! And then you kind of think man this is too spectacular! We're just learning so why not, if there is a God, if someone says 'there is', why not? Could be..." HP Interventions includes the sub-category of Signs. It was mentioned by four interviewees. Annie said: "I've thought sometimes that there is no such thing as coincidence. What makes that possible? I don't know but I do know that coincidences for me are more than just chance…" Three participants state that they perceived them as interventions from the HP. Liz thought about randomly finding a book about alcoholism, and being shown the way to a meeting by a stranger as signs. They are important enough for her to say that without those signs she would have continued drinking and probably died.
"I used to say that there were coincidences and now my perception of that is that there aren't: they are signs given to us, something like conspiring. Human choice is also needed. If you open your eyes, you will realise the HP is reality… There have been many interventions of the HP".
She also remarked that in order to see the signs, she needed to want it. Having opened up to spirituality, she is now much more willing to open her eyes to HP interventions.
Fred also noticed good things happening: "Certain things happened, coincidence maybe? I don't know but good things seem to happen rather than bad. When you're expecting bad things to happen every time, it's an alcoholic way of thinking that: it's the next worse thing going to happen. And then it stops. And more positive things come to your mind rather than negative and… you can't put your finger on it. What is it?" Being looked after is another subcategory of the category of HP Interventions that is very dear to those who mention it. Six interviewees had the assurance of being looked after by noticing interventions, for example: "More and more coincidences give confidence… of being looked after." (Fred) "It's what's in the sky looking out for me… I used to worry a lot just Whatever the interviewees' idea of a HP was, and whether they considered themselves as atheists or believers, they all prayed at least together, set prayers in meetings and sometimes by themselves. All expressed at least some gratitude. Some handed over their cares and some felt a connection. All told of interventions of the HP or of "Something" in their lives. They may have noticed those interventions in what some might call coincidences, in some mysterious protection, or in the fact that they've remained sober even through difficult times, which five interviewees said was miraculous. (Table 1) Theme 3: Higher power impact: That theme arose in response to the question asked about the influence of the HP on the participants' lives. There weas Impact on Relationships, Impact on Work, Impact on Health and During problems.
From Impact on Relationships, 3 subthemes were extracted: with Self (including categories of Sobriety, Looking after one's needs, and Trust in Future); with HP (including Shift and Program); and with Others (including Relationships and Work).
The first category of impact on Self is that of Sobriety, emphasised by most interviewees. The HP is behind the 'miracle of sobriety', as Liz calls it. There was a "…HP intervention for me to stop drinking!" (Liz).
"…gives boundaries, which are needed otherwise I would drink if things were made too easy" (Emma).
The category of Looking after one's needs is seen as consequence of having a HP: "I'm looking after myself. And this is where God is doing something for me that I couldn't do for myself. Left to my own devices, this would not be happening." (Alex) "…I've lived with an illness that wants to feed in the doom and disaster, negativity; now I need this power to know that it's gonna be ok when these automatic negative thoughts come up. I've got this power to say no." (Carl) "I think that my HP wants for me what I want for my children on a good day. So I try to treat myself the way my HP would treat me; in my everyday life what that means is that I do things that I didn't use to do when I was drinking. I am not gonna sound very revolutionary but I eat at meal times, don't skip meals, get enough rest, and exercise. I have healthy food, and I don't drink caffeine because it doesn't suit me." (Alex) Attendance at meetings is perceived as an important part of taking care of oneself.
"I pretty much go to a meeting a day anyway, so I have that level of reinforcement… on a daily basis." (John).
"I guess that's another aspect of how the rooms work because ultimately we're all in the rooms because we're flawed, we've all done bad things, and it's that that does level pride, that does make us all of the same level." (Emma) "… it's just this, they call it a hole in the soul in meetings, and I love being with people who feel like that; it makes me feel like I'm not the only one, it normalises it, it comforts me a lot to be around other people who feel that way." (Lily) "Team work gives hope and faith." (Fred) "My perception of the HP has changed in the rooms… Listening to people has liberated me from dark Catholicism" (Emma). "Opening up instead of keeping plan secret kept me sober… Going to meetings, getting support, and talking about temptation, prevents it building up… I pick up pointers in meetings. Sharing at meetings makes me feel stronger." (Fred)

HP views
Trust in the future is a category that represented a new vision for the majority of participants.
"I used to worry a lot and always have a fear of death, a bit of an obsession with it, just fear. It takes away that fear because it's like: it's ok, you're looked after." (Emma).
"I feel like it's just the beginning. It's almost like waking up… from getting sober till now. Slow process. And I realise that now I'm at the place of healing the mental illness part of the disease; the physical addiction, the compulsion has been lifted." (Liz) "…I've changed and now I've got back faith that everything is gonna be ok, no matter what, it's gonna be alright." (Carl) The subtheme of Relationship with HP was related as important to eight interviewees.
Four participants said that their new unconditionally loving HP helped them to value themselves and to reinterpret life events.
"…it's very comforting in that there is this idea of what God wants you to be. If God -HP -has a plan for you… if we kind of listen out to what the HP is telling us, we're gonna get on the right track. This is kind of reassuring, that what is for me is not gonna go past me that it's there but I just need to kind of be aware." Emma and Liz noted that handing over enabled humility.
"It's humility as well because even when you feel really bad about yourself you're usually self-important, so... taking that you're not actually that important -not in a bad way but just in a way that's easier to live with… just hand it over!" (Emma) "The HP is important because it makes me more humble. It rightsizes me… I would think that I was better than everyone and I knew more than everyone and… it's just not like that anymore at all." (Liz).
"…gives the right perspective of self as even feeling bad about oneself comes from self-importance… there is no guilt". (Emma) After three years in AA, Liz said she was still in the process of remembering the HP and thought it would last a life time for whoever sets up to learn it. "My first awakening… moments of clarity… it was like someone shooting a diamond bullet in my head. Just sitting at home, I was suffering a great deal with… losing someone and I had to look at myself, my part in causing the suffering and something made me accept some of my shortcomings. It gave me a warm feeling… a vision… It's a great irony that something I didn't want to look at -didn't want to acknowledge my shortcomings at all in life -when I did, I was rewarded with… a vision with feelings… exciting!" (Gabe) These shifts enabled participants to see the bigger picture; six of them related seeing the good out of bad situations. In spite of pain, there were moments of trust. Good came out of a bad situation. In fact if it hadn't been for the past bad situation, things would not be as good now.
"With the HP, things will be alright in the end. If things are not alright, it's not the end" (Liz) "God telling me to slow down… hearing God's message turned a negative into a positive". (Fred) "It makes it possible to see a bad event as what was meant to be, knowing there is a bigger plan…It feels nicer that way, more connected. Things feel more connected, I like it… I feel more connected to the universe and the bigger thing. Yea and things… seem to have more purpose." (Liz) Applying the category of Program had positive consequences in the lives of all participants Gabe quoted AA's promise 'We will not regret the past nor wish to shut the door on it', as his outlook had changed. Sobriety and belief in a HP as benevolent force enabled him to see a great range of skills and experience in his CV, where he used to see catastrophes. He is now "…comfortable looking back." Sponsors advise to do a nightly list of things one is grateful for.
"I just wanted life to end, and I don't have… one of the things that I try and do is a gratitude list which I share with other people and certainly from a mental health kind of perspective I was not grateful for anything at the end of my drinking, now I'm grateful for everything really." (Gabe) In the subtheme of Impact on Relationships with others, 7 interviewees reported a change. Carl and Emma said they had the ability to love with others because their new HP was loving and accepting.
"It's given me an ability to love… So… because my HP loves me unconditionally, I've learned to love myself. I know there's something out there loving me, unconditional, no matter what I do, that this thing is gonna love me. And that's where my recovery's been shifted" (Carl) "Because I've got this HP who says, 'Listen, if you're trying to be a good person and if you're not intentionally screwing people over, including yourself, then I am happy', it affects me in the kind of person I'm trying to be and the kind of teacher I'm trying to be, just kind of loving and accepting of others -not with the prescriptive list of what I want them to be like -loving their flaws, loving people's flaws, loving." (Emma) When Liz noticed that she felt inferior, she avoided her old pattern of being nasty.
"…I start to feel less than, because I know that my disposition is then to not be very nice, I can remove myself, think, perhaps do a mental gratitude list very quickly about what I have, and realize that my lesson is actually: 'Just an imagining.' It's not real." Gabe reported learning to have good relationships: "…it has no doubt affected my relationships… I've learned by it. So that's where I'm trying to learn now is to have good relationships with people. You can still be talkative and friendly but know where the boundaries are. When… the first 42 years of my life I didn't have any boundaries…" "I don't even appreciate sarcasm in the way that I used to. I'm much different… much calmer, I'm less frenetic… they used to call me like a bumble bee on speed… I smile a lot more, yea so yea, relationships are totally different. Yea, thank God!" (Liz) "I can take care of myself so that I can be available to people. I couldn't do that, having to take care of myself. So I wasn't really, I'd be in a hurry or under pressure or feeling stressed or angry." (Alex) In the subtheme of Impact on Work, five people related how they had changed. Alex was able to handle the thought of tasks that used to overwhelm him. Annie was satisfied in being self-employed after having been in a highly pressured post. Dom had left his very stressful job for a better one. Though there was still pressure there, morning meditation and prayer made it ok.
"…I changed. The job that I did… I thought I had to have the perception of being ruthless and calculating. I thought I had to be cunning and calculating… but I saw things through a negative perspective. And I changed a lot now..." (Gabe) "the knowledge that it requires work to be happy -it's not an entitlement -or contented, or whatever the goal is, is definitely a new thing for me."(John) ( Table 2).

Discussion
The purpose of that research was to find how AA members' understandings of a HP impacted them. The AA literature talks about "God as we understood Him." (AA, Step 3 and 11), leaving up to each member to interpret God as they wish, the expression Higher Power giving even more freedom of choice. It would be useful to find out whether different choices led to different outcomes.
The research question was: How do AA members understand the HP? To answer it, the relationship the participants had with that HP and how it affected not only their sobriety, but their entire lives, including relationships, work, etc., had to be explored.
Religion and spirituality have been evidenced to affect substance abusers positively, resulting in less anxiety [30]. Many alcoholics suffer from anxiety. Their addiction is most of the time an attempt at selfmedicating it. "At least two thirds of alcohol-dependent individuals entering treatment show evidence of anxiety, sadness, depression and/or manic-like symptoms... self-medication has been proposed as an explanation for alcohol consumption in people with... anxiety and depression." [31].
Also, recently: "About 20% of people suffering from social anxiety also developed an alcohol use disorder. There is also a reverse relationship, with 15% of alcohol abuse cases linked with symptoms of social anxiety." (http://www.castlecraig.co.uk/blog/06/2015/socialanxiety-and-addiction accessed on 6/6/2015) As a lot of people in the UK have issues with religion, AA's concept of a HP could give its members the opportunity to accept spirituality free from religious dogma. This applied to most participants of this research, but particularly to Emma, who felt 'liberated' from a stifling religious background and to Carl, who came from atheism, as they both embraced a loving HP.
Qualitative research has been compared to an adventure, an exploration [25]. This one seemed like the exploration of a territory where extraordinary people lived, the survivors of life after drunk.

Alex
Better with wife and children Better with self: After doing 12 Step, now working on mental part of the disease Looks to HP, meditates, looks forward to future bigger picture The one other research on the subject of the Higher Power at Chester University [32] is not one engaging with narrative through the use of open ended questions like this one, but is one conducted with the use of questionnaires. It is ongoing and not yet finished.
As noted in the literature review, lasting recovery comes more from practicing the AA program than mere meetings attendance [33]. Most important AA recovery behaviours involve working the steps [34] in which the centrality of the HP, even of God, cannot be avoided. All participants in this research practiced other aspects of the program than just attending meetings. It was obvious from what Alex -the oldest member (over 20 years of AA membership) -said, that he was commonly sponsoring other members. That was identified in previous research as one of the best predictors of sustained recovery [34].
Being asked what impact the understanding of the HP had on their lives, the participants could have taken that question as meaning the impact of AA itself on their lives. AA, with its program, can also be a HP, or for some at least an instrument of the HP.
It could be thought that different understandings of the HP in AA lead to different outcomes in life. But it seemed that the simple fact of having a belief in a HP, any HP, impacted AA members' lives positively. And it is not just the understanding but the living and the practices that affected the interviewees.
In this small sample population was a wide range of backgrounds and understandings of the HP. The two participants who seemed to have the most difficulties in their lives were both atheist intellectuals. They struggled with the very concept of a HP. Annie, the most intellectual, which described herself as an academic, still had occasional thoughts of suicide. John was more satisfied in his life. He realised, and tried to avoid thinking about it, that those who did best in AA seemed to be the ones with the closest relationship with their HP. Nevertheless, they both managed to not only stay sober but be content in doing program-recommended practices, one majoring on meditation, the other one on meetings attendance. The third declared atheist, Fred, not an intellectual, integrated more of the HP concept by interpreting it as being in nature and in his conscience.
Intellectualism, at least as much as atheism, seemed to get in the way of acceptance of a HP.
On the other hand, the two participants who seemed the most contented with their HP had a childlike view on it and were educated but not intellectuals. They both felt looked after by their unconditionally loving HP. Both had shifted from their former beliefs, Emma from Catholicism, Carl from atheism. Two other participants were quite passionate about their HP. Gabe, who had lost well-loved family members to alcoholism, had recently gone through a shift which led him to see altruism as the way to live. Dom had found refuge as a child from his parents' alcoholism and cold atheism in church where he had received an enduring faith. Later, driven away from established religion for its intolerance, he had clung to his faith not knowing how to practice it. Coming into AA had set him free to live his love for God while practicing the program.
The three other participants in our study had never rejected religion. Alex and Liz appeared quite satisfied, trusting their HP to take care of them, believing that "more shall be revealed". The third one, Lily, whose emotional life had been transformed by meditation, was now searching through prayer for a closer relationship with the Love HP she perceived in other members.
This study confirmed the importance of social peer support [21] but for some like Dom, it would be nothing without the HP.
The agreement of researchers about the centrality of contact with God in AA fits in with those findings [20,35].
The part played by spirituality in recovery has already been stressed in studies such as Marc Galanter's Spirituality and recovery in 12-step programs: An empirical model, "A program like AA is described here as a spiritual recovery movement, that is, one that effects compliance with its behavioural norms by engaging recruits in a social system that promotes new and transcendent meaning in their lives". (2007) Other elements of this study findings, mentioned here as factors of recovery by Participants such as Gratitude, Socialisation, Prayer, or Humility fit in well with a number of other published studies, notably within areas of Positive Psychology [36][37][38].

Possible future research
Research has been done on the effects of different treatments on addiction recovery. It would be useful to further investigate how the diverse backgrounds of AA members affected their understanding of a HP, which seems so central to their recovery. In this small sample, two participants had come to AA via Addiction Treatment first, both atheists. Treatment appeared to have been what eased them into AA. Annie said it would have been too difficult to go into AA otherwise. Another area worth exploring would be how the different understandings and relationships with a HP affected the degree of contentment of AA members.

Conclusion
The greatest consensus of the HP participants' understanding of the HP was on adjectives rather than nouns: benevolent, compassionate, good, forgiving, kind, always there for me, unconditionally loving.
The noun most commonly used for the HP was Love, like Liz said: "There's just love really, and I think for most of us that would be the same, certainly the people I know in AA".
Love and God are defined as synonymous in Scripture: "God is love" (John, Epistle 1, chapter 4, verse 8b). As is often quoted, "a rose by another name would smell as sweet" (Shakespeare, 1600, Act 2, scene 2) [39] The name Love may be used in place of the word God, free from negative connotations.
The word God is often used in the Big Book, along with other names, "Supreme Being", "Presence of Infinite Power and Love", etc. As said above, for those resisting its religious connotation, the term HP is more acceptable. Paradoxically, Carl, who can get virulent against the use of the word God, shows most enthusiasm about his Love-HP, which he sometimes inadvertently calls "my God" .
Emma, who felt liberated when she rejected her former Catholic religion, is thrilled to know she is "being looked after" by the unconditional love of her HP in the sky. Liz, coming into AA, felt that at last she was given permission to have a HP. For her, those who argued about the word God had no point. Dom, who "always believed in God", needed tolerance and found it in AA where he was able to develop a closer relationship with is HP. But he feels he has to be discreet about it there. It took him a while in the interview to feel enough trust to mention that his HP was Jesus.
AA members discover in Step 11 that the program is about getting closer to a HP, "Sought through prayer and meditation to improve our conscious contact with God as we understood Him..." God, under the name of Love, still seems central to the AA program. In the interviews, the closer participants' understanding of the HP was to Love, the more contented they seemed to be with their lives (Table 1).
A note about the context of this research: unlike the US, England is quite a humanist secular society. It is not surprising to have found the idea of God strongly rejected by some AA members. However it is worth noting that AA with its HP concept gives them the ability to progress at their own pace as they "come to believe that a power greater than ourselves could restore us to sanity" (Step 2) [61 -73].