Abstract
Alcoholics Anonymous (AA) offers a live stage to study how humility is worn by thousands for another day of sobriety and more freedom from the bondage of self. It has been the coauthors’ intent to emphasize the significance of humility as a cardinal virtue across the 12-Step program and as essential to all its key elements. The coauthors have placed this emphasis in the context of a wider theological history of thought as this converged on Bill W. and AA. In addition, the coauthors have offered a constructive developmental interpretation of the 12 Steps that relies on a model of four modulations of humility. Finally, the coauthors have reviewed in brief some approaches to the measurement of humility in this context, and suggest several aims for future research.
Keywords: Alcoholics Anonymous, 12-Step recovery, humility, virtue
Introduction
What does humility mean in the context of Alcoholics Anonymous (AA) and how does it function in the process of recovery? In AA circles, humility is the virtue of the individual who is no longer an “inflated” self and is now a worker among workers. To use a favorite AA expression, he or she is “not God” (Kurtz, 1991). Helping others—and other alcoholics in particular—becomes a humble daily practice that benefits recipient and helper (Pagano, Post, & Johnson, 2011). In this article, we first consider philosophical and theological perspectives on humility, then discuss humility in the context of AA, and offer a framework for understanding the 12 Steps by constructing a model of four modulations of humility. We conclude with directions for future research on the role of humility in addiction recovery.
Philosophical and theological perspectives on humility
AA does not adhere to the concept of humility that equates with what Aristotle called micropsuchia, or “lowliness.” Aristotle (1941) rejected lowliness because for him a virtue is a mean between two vices, in this case, between vanity or self-inflation and a lowliness that forsakes one’s true value (pp. iv, 9). Similarly, Spinoza (1677/1994) distinguished the virtue of humility from abjectio, or a self-abnegation that thinks less highly of self than is accurate or justified, usually out of sadness or exaggeration (pp. iv, def. 29). Both these philosophers remind us that while the inflated self is unbecoming, so also is its antithesis, the deflated or collapsed self that is does not act consistent with human dignity. Kant (1797/1964) follows suit in his The Metaphysical Principles of Virtue, where he distinguishes servility or “false humility” from “moral humility,” or the consciousness of the insignificance of one’s own moral worth in comparison with the moral law (p. 81). Kant held that kneeling on the ground even to express reverence for heaven is contrary to the absolute human dignity of being a rational moral agent and amounts to groveling (Comte-Sponville, 2001).
Theologically considered, there are two basic views on humility in the history of Western thought. Thomas Aquinas (1264/1991, pp. iv, 55) held that humility is keeping oneself within bounds and avoiding inordinate self-esteem while avoiding the opposite error of hypocritical self-abjection. He stressed the “rational principle” of right ordering of love (ordo amoris) with God first, and then neighbor and self at equal seating. Humility in this tradition has to do with our being in the image of God due to our having an eternal soul, but only as fleeting finite creatures who are limited in all the ways that God is not. In other words, humility has to do with living in accordance with the objective order of being as is self-evident to the rational mind. This understanding of humility is consistent with the AA concept as presented by the renowned historian of the movement Ernest Kurtz, in his classic work The Spirituality of Imperfection. Kurtz and Kethcam (1992) write that humility signifies “the acceptance of being human, the acceptance of one’s human being” (p. 187), and a wariness of grandiosity. It also involves the recognition and the acceptance of our imperfections as a path to tolerance of others (p. 192). In essence, arrogance is ontologically irrational.
But there is a second and generally more Lutheran view on humility that is “voluntarist” in the philosophically technical sense of this term: the will is the fundamental or dominant factor in the individual or the universe. Thus, the “voluntarism” of the Reformation placed emphasis not on reason but on submission to divine will so as to displace self-will. Fred Buchanon, founder of the Oxford Group movement of which Bill was a part, was an evangelical Lutheran. For Luther, humility meant the full acceptance of God’s will, and unconditional dependence on that will rather than on one’s own. Echoes of this type of humility can be found in the 12 Steps. Step 3, for example, reads, “Made a decision to turn our will and our lives over to the care of God as we understood Him,” and Step 11, “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out” (Alcoholics Anonymous [AA], 1952). This is not an endorsement of the power of reason to see the right ordering between self, neighbor, and God, for Luther and the Reformers were all highly skeptical of the capacity of reason to be other than rationalization of selfishness. Thus, spiritual transformation as manifest in “surrender” to a divine will however construed, is the key.
In the 12-Step program, submission and rightly ordered human will in relation to God are underscored with a twist—members are to find a God of their own understanding, and to use their own personal experience as evidence of a better way of life that unfolds from the practice of AA’s principles. The surrender of one’s will to a God of one’s own understanding paradoxically results in freedom from the bondage of self—a theme that Luther (2008) himself articulated in his classic 1520 treatise On the Freedom of a Christian in which the deepest from of freedom is the inward freedom from self through dependence on divine will. As stated in Twelve Steps and Twelve Traditions, “And the facts seem to be these: The more we become willing to depend upon a Higher Power, the more independent we actually are” (AA, 1952, p. 36).
The AA historian Jared Lobdell identifies Catholic and Lutheran influences on the construct of humility as discussed in 12-Step literature and Bill W’s writings. Lobdell (2004) identifies humility in the Catholic sense as a matter of
keeping oneself within bounds, not reaching out to things above or beyond one’s proper sphere: it is part of the cardinal virtue of temperance inasmuch as it represses inordinate ambition and inordinate self-esteem without allowing the opposite error of exaggerated or hypocritical self-abjection, and it thus subjects will and reason to God. (p. 266)
Yet Lobdell also points out Lutheran influences on AA’s understanding of humility (via the Oxford Group) as complete and unconditional submission of the human will.
Humility was a highly popular theological topic in Bill W.’s era of the 1930s. The renowned theologian Reinhold Niebuhr (1939/1996), like all the existential theologians of the 20th century, reminded us in his 1939 Gifford Lectures that we are children of the earth, or children of humus, frail and finite, with trouble accepting our limited selves as “grounded in the earth.” Because we fail to accept our human limits, he argued that we think of ourselves as gods and manifest a “will to power” over others. Yet Niebuhr was always skeptical of excessive self-denial. So also was Dag Hammarskjold (1968), then secretary general of the United Nations, who wrote under Niebuhr’s influence when he described humility as just as much the opposite of self-abasement as it is of self-exaltation. The humble self is “secure in its reality,” and is “neither better nor worse, bigger nor smaller, than anything else in the universe” (Hammarskjold, 1968, p. 174).
The Niebuhrian tradition of the mid-20th century maps onto AA’s description of the absence of humility—which can be expressed on the one hand as self-degradation, self-pity, or unworthiness, and on the other hand as grandiosity, exhibitionism, or vanity. Either direction is a skewed perspective on self that lacks genuine humility, without which the self is prone to addiction. In a poplar phrase of the time, “When God goes the half-gods arrive.” Yet humility in the sense of being rightly ordered in relation to God does not translate into servility or inferiority in the 12-Step program. As the book Alcoholics Anonymous, first published in 1939 (AA 1939/2001), states, “We should be sensible, tactful, considerate and humble without being servile or scraping. As God’s people we stand on our feet; we don’t crawl before anyone” (p. 83).
When AA was founded in 1935, Niebuhr’s famous Serenity Prayer immediately became an AA mantra. In essence, this is a prayer for serenity through the dynamic of humility: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Although we have the power to change some things, our powers are limited. In the 12 Steps, one thing no alcoholic can change is the reality of his or her addiction. Only a humble dependence on a Higher Power can do that.
Throughout Niebuhr’s (1939/1996) writings, it is humility that makes space for the love of neighbor. In the absence of humility the self takes up (occupare) all the available space in the room of being and no other person can fit into it. In humility love makes space for others as equally regarded by a loving God. In this shift from relating to others purely to the extent that they contribute to selfish agendas, the self finds freedom. Humility then is freedom from the falsehood and delusion of placing self at the center of the universe. As Bill W. saw it, to recover requires the alcoholic “to gain a vision of humility as the avenue to true freedom of the human spirit” (AA, 1952, p. 73).
AA’s perspective on humility has had influence on positive psychology. The most significant contemporary conceptualization of humility is found in Character Strengths and Virtues: A Handbook and Classification (Peterson & Seligman, 2004), the key text of positive psychology. The chapter on “humility and modesty” draws directly its first page from an analysis of Bill W., who “wavered between arrogance and low self-esteem” (Peterson & Seligman, 2004, p. 461). Key features of humility identified in this handbook include “an accurate” sense of one’s abilities and achievement, a nondefensive willingness to see oneself including strengths and limitations, openness to new ideas, keeping a low focus on the self, and affirming the value of all people and the different ways they contribute to our world. A self-disparagement or contemptuous attitude toward the self is to be avoided, as is an over-estimation of the value of self in relation to others (p. 462).
We assert that in AA humility is a virtue within a wider community that encourages the well-being and care of the self and celebrates achievements on the path to sobriety. It is a positive humility that serves as antidote to destructive belittlement of self or others. Such humility includes love of self, but only the love of the right and true self that is situated within the framework of meaningful community and a Higher Power. Humility is contrary only to love of the wrong self, the self-inflated being who relates to others merely insofar as they contribute to the narrow narcissistic agendas of the self, and not as independent centers of worth in themselves. Humility is thus contrary to what Buber (1925/1971) referred to in his classic 1925 work I and Thou as “I–It” relationships where I am at the center of the universe and all else revolves around “me.” However, it is supportive of “I–Thou” relationships where the self is no longer at the center of the universe and relates to others as of equal value. Indeed, the I of “I–Thou” is expanded and ineffably more flourishing than in the “I–It” universe (Buber, 1925/1971). In other terms, humility refers to an accurate sense of self and its place in an equal-regarding community.
In feminist perspective, the affirmation of the true self that humility requires is an important counterpoint to the denigration of women in terms of “selflessness” and “self-abnegation.” In AA meetings women are by no means voiceless, but on the contrary, they are empowered to speak for themselves and are equally regarded in a setting that is devoid of male hierarchy or of hierarchy of any kind. In the context of Step 7 (see below), women in AA often speak of learning to care for themselves, speak for themselves, and of not depending on how others—and men in particular—evaluate them. As a gross generalization, for women the challenge of humility is less one of overcoming self-inflation and more one of overcoming their having been deflated and undervalued in domestic life and in society (Covington, 2000). For anyone who has been marginalized or diminished in social equality and who has internalized the cultural message that they are supposed to serve men and be without a self in the sense of having any first-order desires and interests, humility is likely to be equated with humiliation unless careful efforts are made to distinguish the two (Post, 1988, 1990). This is an area for future gender research in AA studies.
AA’s perspective on humility
AA (1952) posits humility as the platform on which all 12 Steps are built. AA’s most ample discussion of humility is in the chapter “Step Seven” in the Twelve Steps and Twelve Traditions (pp. 70–77). Step 7 reads, “Humbly asked Him to remove our shortcomings.” The second paragraph of the chapter is worth quoting in full:
Indeed, the attainment of humility is the foundation principle of each of A.A.’s Twelve Steps. For without some degree of humility, no alcoholic can stay sober at all. Nearly all A.A.’s have found, too, that unless they develop much more of this precious quality than may be required just for sobriety, they still haven’t much chance of becoming truly happy. Without it, they cannot live to much useful purpose, or, in adversity, be able to summon the faith that can meet any emergency. (p. 70)
Humility is described herein as a “precious quality” and as “the foundation principle” upon which all else depends, including spirituality, contrition, and service to others.
Four modulations of humility
Different modulations of humility are cultivated through continued step work. We propose four modulations of humility that are fostered by the 12 Steps. We do not assume that all individuals progress consecutively through these modulations, though there is a probable developmental formative process. Humility levels can wax and wane to the extent that the associated steps are practiced.
One: Humility as complete defeat before a Higher Power
Steps 1 through 3 focus on admitting powerlessness over alcohol and reliance on a Higher Power of one’s own understanding. A life propelled by self-will has failed, leaving open the door for open-mindedness in relying on God. We recognize that the experiences of women with regard to “selflessness” and voicelessness in domestic and societal patriarchy may make this “complete reliance” less theologically and psychologically salient for them (Covington, 2000).
Step 1, as stated in Alcoholics Anonymous (AA, 1939/2001, p. 59) and 13 years later in Twelve Steps and Twelve Traditions (AA, 1952, p. 21), underscores the critical importance of admitting complete defeat over alcohol and that one’s life is unmanageable: “We admitted we were powerless over alcohol – that our lives had become unmanageable.” As Kurtz (1991) emphasizes, Bill Wilson stressed “deflation at depth” because he knew from experience that no middle of the road stance in this admission would allow an alcoholic to recover (p. 21). Humility is required in conceding to one’s inner most self that one is powerless over alcohol and that one’s life has become unmanageable. This form of humility, which verges on the humiliation of realizing that reliance on self in overcoming addiction has totally failed, does not come easy. Yet it is a necessary first step to radically reduce an inflated self-perception. In AA theory, pain, suffering, calamity, or hopelessness is usually required for alcoholics to admit complete defeat over alcohol and the unmanageability of their lives.
Two: Humility as accurate self-appraisal
Steps 4 through 7 are often referenced by AA members as the “cleaning-up” steps of the program and foster humility in the form of accurate self-appraisal and admission of fault rather than the self-deprecation associated with the first modulation. These steps involve conducting a thorough personal inventory as outlined in chapter five of Alcoholics Anonymous (AA, 1939/2001, pp. 65–69) and sharing it with another who may or may not be a sponsor. Without sharing one’s personal inventory with another the alcoholic “never completed their housecleaning” (AA, 1939/2001, p. 73), though they may mistakenly think that they have: “But they had not learned enough of humility, fearlessness and honesty, in the sense we find it necessary, until that told someone else all their life story” (AA, 1939/2001, p. 73). Conducting a personal inventory with another alcoholic can correct a blind spot in the alcoholics’ thinking and deepen their insights into their selfishness. With Step 7, “Humbly asked Him to remove our shortcomings,” the alcoholic acknowledges that it is ultimately a Higher Power that alone can create deep and lasting change in the self.
Three: Humility of contrition
Steps 8 and 9 are referenced by AA members as the “making up” steps of the program. These steps require humility to admit how one has harmed others and ask them now how to set the matter right. Willingness to work for humility of contrition is fostered by AA’s reminder that amends are made to set the alcoholic’s human spirit free, for serenity, and real peace of mind, regardless of how an amend is received.
Four: Humility of a rightly ordered self in relation to God and others
Steps 10 through 12 are about the humility of sustaining a rightly ordered self in relation to God and others that is practiced in one’s affairs. One actively seeks out God’s will rather than forcing one’s agenda, carries the message of recovery to other sufferers, and practices the principles of love and tolerance to others in all one’s affairs. The 12th Step of helping other alcoholics is predicated on a deep formation in humility.
However, no alcoholic seeks perfection in humility because the very idea of “perfection” is contrary to humility. The alcoholic strives to goodness in benefitting others but acknowledges and tolerates inevitable human flaws in self and in others. Kurtz and Ketcham (1992), in The Spirituality of Imperfection, write that humility accepts the self as imperfect first, and as a result will refrain from “judging others” (p. 195). Humility focuses the self on living with its own shortcomings, which increases tolerance of others.
In sum, we describe four modulations of humility that step work cultivates:
The desperate acknowledgment of an inflated and failed self before a Higher Power
An honest self-appraisal shared with another person
Making amends to those harmed where possible
Right ordering of self in relation to God and others that is practiced in one’s affairs.
Measuring humility in AA
To conduct empirical research, quantification of the construct under study is required. Unfortunately, there are sparse tools to measure humility as operationalized in AA. In this section, we turn to existing measures that map onto components of humility as referenced in 12 Step literature. In the social sciences, humility has been operationalized as a set of traits: an accurate assessment of one’s strengths and weaknesses, willingness to admit mistakes, openness to new perspectives, absence of self-centeredness, and appreciation of others (Peterson & Seligman, 2004; Tangney, 2000). The General Humility Scale (Hill, Laney, & Edward, in press) was informed by this work and may tap facets of humility in AA. This scale is a 13-item questionnaire with three dimensions: low concern for status (i.e., “Getting special attention from others is not that important to me”), other orientation (i.e., “I know I have done well at something if it benefits others”), and accurate self-assessment (i.e., “To view myself more honestly, I am willing to face things I don’t like about myself”). This scale may tap facets of humility in AA. For example, not needing special attention from others aligns with acceptance that one is not the center of the universe, which occurs in Step 1. Facing things one does not like about oneself pertains to the humility of honest self-appraisal, the focus of Step 4. Seeking to contribute to the lives of others is a signal of the humility of a rightly ordered self, a focus of Steps 10 through 12.
Instrumentation of behavioral change processes in AA has significantly advanced in the 21st century. The 24-item General AA/Narcotics Anonymous/CA Tools of Recovery Scale (GAATOR; Greenfield & Tonigan, 2013), the 16-item Daily Spiritual Experience Scale (DSES; Underwood & Teresi, 2002) and the 12-item Service to Others in Sobriety questionnaire (SOS) contain items that map onto the four modulations of humility in AA (Pagano et al., 2013). For example, the GAATOR item “I have believed that my recovery could only come from a power greater than myself” maps onto the humility of honestly admitted powerlessness. Listening to another alcoholic without interruption for 10 minutes is an SOS item that signals being teachable and not in the role of the director—an extension of the humility of honestly admitted powerlessness. The GAATOR item “I have found character defects which I am willing to give up” connotes humility of accurate self-appraisal. Another GAATOR item “I have made direct amends to those whom I had harmed” signals the humility of contrition. The DSES item “I ask for God’s help in the midst of daily activities” is evidence of the humility of a rightly ordered self in relation to God and others.
Empirical research on the role of humility in 12-Step programs of recovery is in its infancy. Without humility, these programs argue that motivation for learning how to stay sober and to make sober lifestyle changes is likely to be low. Our data suggest that adolescents who enter treatment with higher humility have greater motivation to stop drinking and using drugs (Pagano et al., 2016), and that spiritual virtue and humility are linked (Lee, Pagano, Johnson, & Post, 2016). Our findings suggest a relationship between religious practices, spiritual experiences, service to others, and a number of outcomes, including humility, desistence from delinquency, and alcohol and other drug (AOD) recovery. We hope to further explain these variables in future research. As humility research advances, we may discover humility to be the catalyst in internal shift processes in relating to others and increased spirituality. For example, humility in terms of rightly ordered self in relation to God and others may promote an intrinsic motivation to help others that derives from a genuine desire for their well-being, as opposed to helping others for self-centered reasons (Konrath, 2014). These complex transitions can be studied once foundation research in humility is advanced. We discuss directions for future research in humility to lay cornerstones in place for this new area of 12-Step research.
Future research
Empirical research on the role of humility in addiction recovery begins with the quantification of humility in AA, understanding of humility’s effects on outcomes such as sobriety and criminal behavior, and the factors that prompt increases in humility. Thus, we propose these three aims for future research:
Aim 1: To measure humility in AA
The instrumentation to date represents strides in quantifying humility along the spectrum of step work. Although yet to be validated among adolescents, adult, and offender populations, items from the GAATOR provide a place to start quantification of the first three modulations of humility (above). We know the least about how to assess the fourth modulation of humility, although the SOS and the DSES may provide some guidance. In-depth interviews and focus groups with young alcoholics/addicts in recovery are needed to capture the picture of what this modulation of humility looks like in daily practice. Our qualitative work with this population points to an attitude of tolerance. It may be easier to identify the lack of humility in this modulation—not feeling superior, inferior, or envious of others, not trying to be the “driver of the bus” (lacking patience and tolerance of others), and low conscious contact with a Higher Power. Developing a brief and valid instrument of humility with items of measure for four distinct but related modulations that can be summed for a total score is a new frontier to advance the field of 12-Step research and contribute to treatment practices.
Aim 2: To examine the impact of humility on outcomes
Although humility has been foundational to all 12 Steps since their conception, empirical evidence of the benefits of humility on treatment outcomes have yet to be studied. For humility to be sought as a character strength much like persistence and self-regulation requires empirical evidence of its benefits on health and well-being. We hypothesize that increases in humility will be associated with greater abstinence from alcohol and drugs, reduced recidivism, greater well-being, reduced self-absorption and inflated self-perception, and improved interpersonal relationships.
Aim 3: To identify factors associated with increases in humility
Traditional views conceptualize readiness to change as driven by accumulating consequences in accord with the perspective that alcoholics need to “hit bottom” before they become “motivated” to change. The admission of complete defeat and willingness to adopt attitudes and actions does not come easy to alcoholics, whose defining characteristic is defiance. Aptly phrased by Bill W.:
Who wishes to be rigorously honest and tolerant? Who wants to confess his faults to another and make restitution for harm done? Who cares anything about a Higher Power, let alone meditation and prayer? Who wants to sacrifice time and energy in trying to carry A.A.’s message to the next sufferer? No, the average alcoholic, self-centered in the extreme, doesn’t care for this prospect—unless he has to do these things in order to stay alive himself. (AA, 1952, p. 24)
The purpose of this aim is to identify the factors that precipitate increased humility in admitting complete defeat as operationalized by the first modulation of humility (above). The cumulative influence of being overwhelmed by craving, consequences, and drinking quantity, frequency and history may predict greater surrender before a Higher Power (first modulation of humility). Stress, psychiatric symptoms, expectancies (i.e., self-efficacy), trauma history, and environmental factors (number of drinkers in environment, quality of environment) may also influence the first modulation of humility.
Conclusions
AA offers a live stage to study how humility is worn by thousands for another day of sobriety and more freedom from the bondage of self. It has been our intent to emphasize the significance of humility as a cardinal virtue across the 12-Step program and as essential to all its key elements. We have placed this emphasis in the context of a wider theological history of thought as this converged on Bill W. and AA. In addition, we have offered a constructive interpretation of the 12 Steps that relies on a model of four modulations of humility. Finally, we have reviewed in brief some approaches to the measurement of humility in this context, and suggested several aims for future research.
We propose that the study of humility is best operationalized not through a merely abstract analytical philosophical venue, though we pay considerable analytic attention to definitions and the history of thought as all good science must. Rather, humility should be approached primarily through the empirical study of the lived reality of humility as a cardinal spiritual and theological principle and heuristic key to one of the 20th century’s most successful social experiments in applied spirituality.
Acknowledgments
Funding
This research was supported in parts by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA, KO1 AA015137) and the John Templeton Foundation awarded to Dr. Pagano. The NIAAA and the John Templeton Foundation had no further role in study design, data collection and analysis, writing of the report, or decision to submit the paper for publication.
Footnotes
The authors report no conflicts of interest.
References
- Alcoholics Anonymous. Twelve steps and twelve traditions. New York, NY: AA World Services; 1952. [Google Scholar]
- Alcoholics Anonymous. Alcoholics anonymous. New York, NY: AA World Services; 2001. (Original work published 1939) [Google Scholar]
- Aquinas T. Summa contra gentiles. Notre Dame, IN: Notre Dame University Press; 1991. (Original work published 1264) [Google Scholar]
- Aristotle . Nicomachean ethics. In: McKeon R, editor. The basic works of Aristotle. New York, NY: Random House; 1941. [Google Scholar]
- Buber M. In: I and thou. Kaufmann W, translator. New York, NY: Touchstone Books; 1971. (Original work published 1925) [Google Scholar]
- Comte-Sponville A. A small treatise on the great virtues. New York, NY: Metropolitan Books; 2001. [Google Scholar]
- Covington SA. A woman’s way through the twelve steps. Minneapolis MN: Hazelden Press; 2000. [Google Scholar]
- Greenfield BL, Tonigan JS. The general Alcoholics Anonymous tools of recovery: The adoption of 12-step practices and beliefs. Psychology of Addictive Behaviors. 2013;27(3):553–561. doi: 10.1037/a0029268. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hammarskjold D. Markings. New York, NY: Alfred A. Knopf; 1968. [Google Scholar]
- Hill PC, Laney EK, Edward KE. General humility scale. Journal of Positive Psychology in press. [Google Scholar]
- Kant I. In: The metaphysical principles of virtue. Ellington JW, translator. Indianapolis, IN: Bobbs-Merrill Library of Liberal Arts; 1964. (Original work published 1797) [Google Scholar]
- Konrath S. The power of philanthropy and volunteering. In: Huppert FA, Cooper CL, editors. Interventions and policies to enhance wellbeing: A complete reference guide. Vol. 6. Hoboken, NJ: John Wiley & Sons; 2014. pp. 387–426. [Google Scholar]
- Kurtz E. Not-God: A history of alcoholics anonymous. Minneapolis, MN: Hazelden Foundation Press; 1991. [Google Scholar]
- Kurtz E, Ketcham K. The spirituality of imperfection: Story telling and the search for meaning. New York, NY: Bantam; 1992. [Google Scholar]
- Lee MT, Pagano ME, Johnson BR, Post SG. Love and service in adolescent addiction recovery. Alcohol Treatment Quarterly. 2016;34:197–222. doi: 10.1080/07347324.2016.1148513. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lobdell JC. This strange illness: Alcoholism and Bill W. New York, NY: Aldine de Gruyter; 2004. [Google Scholar]
- Luther M. In: On the freedom of a Christian. Tranvick MD, translator. Mineapolis, MN: Fortress; 2008. (Original work published 1520) [Google Scholar]
- Niebuhr R. The nature and destiny of man. Louisville, KY: Westminster John Knox Press; 1996. (Original work published 1939) [Google Scholar]
- Pagano ME, Delos-Reyes CM, Ferrer M, Nwokeji N, Brager D, Alatise A. What factors predict motivation to change among adolescents entering treatment? Alcoholism: Clinical and Experimental Research. 2016;40:108. [Google Scholar]
- Pagano ME, Kelly JF, Scur MD, Ionescu R, Stout RL, Post SG. Assessing youth participation in AA-related helping: Validity of the service to others (SOS) questionnaire in an adolescent sample. American Journal of Addictions. 2013;22:60–66. doi: 10.1111/j.1521-0391.2013.00322.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pagano ME, Post SG, Johnson SM. Alcoholics Anonymous-related helping and the helper therapy principle. Alcoholism Treatment Quarterly. 2011;29:23–34. doi: 10.1080/07347324.2011.538320. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Peterson C, Seligman MEP. Character strengths and virtues. New York, NY: Oxford University Press; 2004. [Google Scholar]
- Post SG. The inadequacy of selflessness. Journal of the American Academy of Religion. 1988;56(2):213–228. [Google Scholar]
- Post SG. Women and elderly parents: Moral controversy in an aging society. Hypatia: A Journal of Feminist Philosophy. 1990;5(1):83–89. [Google Scholar]
- de Spinoza B. The ethics. In: Curley E, translator and editor. A Spinoza reader: The ethics and other works. Princeton, NJ: Princeton University Press; 1994. (Original work published 1677) [Google Scholar]
- Tangney JP. Humility: Theoretical perspectives, empirical findings and directions for future research. Journal of Social and Clinical Psychology. 2000;19(1):70–82. [Google Scholar]
- Underwood L, Teresi J. The daily spiritual experience scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health related data. Annals of Behavioral Medicine. 2002;24(1):22–33. doi: 10.1207/S15324796ABM2401_04. [DOI] [PubMed] [Google Scholar]