NUR 650
Reply from Alejandro Llanes
Module 3 Discussion I attended a Narcotics Anonymous (NA) group session in West Kendall, Miami, Florida,
specifically at a community-based meeting site near West Kendall, on a weekday evening at 7:00 PM. I selected this meeting because it serves a diverse population affected by substance use disorders and aligns with my clinical interest as a psychiatric mental health nurse practitioner student in understanding community-based recovery resources. Narcotics Anonymous was founded in 1953 as a nonprofit fellowship focused on supporting individuals recovering from drug addiction through peer support and shared experiences, emphasizing abstinence and personal growth (Narcotics Anonymous World Services, 2023). Entry into the program requires only a desire to stop using drugs, making it highly accessible and inclusive. The group consisted of approximately 18 participants, including both men and women ranging from early 20s to late 60s, with diverse ethnic backgrounds reflective of the Miami population, including Hispanic, African American, and Caucasian members. The organization’s primary goal is to provide a safe, supportive environment that fosters recovery, accountability, and sustained abstinence through peer connection and shared lived experiences.
My overall impression of the group was highly positive, as it effectively met the emotional and psychological needs of participants. Members appeared engaged, supportive, and nonjudgmental, which facilitated open sharing and emotional expression. One key therapeutic factor observed was universality, where participants recognized shared experiences of addiction, reducing feelings of isolation and stigma. For example, several members expressed similar struggles with relapse and rebuilding trust, which visibly reassured newer participants that they were not alone in their journey. Another important therapeutic factor was instillation of hope, demonstrated by long-term members sharing recovery milestones and coping strategies, which provided encouragement and motivation for those earlier in recovery. These factors are well- documented in group therapy literature as essential mechanisms that promote behavioral change and emotional healing (Yalom & Leszcz, 2020).
The group process appeared structured yet flexible, with a peer-led leadership style that encouraged participation while maintaining respectful boundaries. Established norms included confidentiality, no interruptions during sharing, and a nonjudgmental atmosphere, all of which contributed to psychological safety. There were minor patient management issues, such as one participant becoming emotionally overwhelmed; however, this was handled appropriately by the group facilitator through redirection, emotional validation, and offering support after the session. Personally, I found the experience meaningful and professionally enriching. It deepened my understanding of the value of peer-led recovery and the importance of community support systems in addiction treatment. The authenticity and resilience displayed by members reinforced the human aspect of recovery beyond clinical interventions. Based on this experience, I would
confidently refer future clients to this group, particularly those who may benefit from ongoing peer support and a structured yet empathetic recovery environment.
Replay Geslande Dessalines
Discussion 3
Alcoholics Anonymous Reflection and Program Overview
On March 30, 2026, at 5:00 pm, I attended a virtual Alcoholics Anonymous (AA) meeting with a group named “How It Works” via Zoom. I chose this specific meeting because I wanted to experience a peer-led recovery group directly, especially in contrast to the Al-Anon family support group I attended earlier in the semester. My goal was to better understand how individuals with alcohol use disorder support one another in a structured, yet informal, setting.
Alcoholics Anonymous is one of the most well-known 12-step mutual-help organizations. It was founded in 1935 in Akron, Ohio by Bill W. and Dr. Bob Smith, whose shared experiences with alcoholism led to the development of a peer-support model for recovery (American Alcoholics Anonymous World Services, 2026). The publication of the Big Book in 1939 formalized the Twelve Steps and guiding principles of AA (American Alcoholics Anonymous World Services, 2026). Since then, AA has expanded globally, with millions of members and groups in over 180 countries, serving as a widely accessible support system for individuals seeking sobriety (Kelly et al., 2020). One of the most unique aspects of AA is its open and inclusive membership criteria. There are no fees, formal diagnoses, or referrals required. The only requirement is a desire to stop drinking (American Alcoholics Anonymous World Services, 2026). During the meeting I attended, there were approximately 20 participants. The group included both men and women, primarily over the age of 40, with a majority being Hispanic White and several African American members. There were slightly more women than men. This reflects the increasing diversity seen in AA participation over time, as it was originally predominantly White males (Kelly et al., 2020). The primary goal of AA is to help members achieve and maintain sobriety while supporting others in doing the same (personal communication, March 30, 2026). This is accomplished through working the Twelve Steps, sharing personal experiences, and fostering a sense of accountability and community (personal communication, March 30, 2026). From my observation, the program was highly effective in meeting participants’ needs. The meeting created a supportive and nonjudgmental environment where individuals felt comfortable sharing personal struggles and successes. This aligns with research indicating that peer-support groups like AA enhance recovery outcomes by promoting connection, shared understanding, and accountability (Kelly et al., 2020).
Several therapeutic factors were evident. First, universality was strongly present, as participants openly discussed similar struggles with cravings, relapse, and emotional challenges. This appeared to reduce feelings of isolation and normalize their experiences. Second, instillation of hope was observed when members shared long-term sobriety successes, which seemed to motivate others. Additionally, altruism was evident as members offered encouragement and support to one another. These factors are consistent with core group therapy principles and contribute to emotional healing and resilience (Wheeler, 2020).
The group process itself was effective. The leader, a recovering alcoholic, facilitated the meeting in a calm and respectful manner. She maintained structure by setting clear expectations such as muting microphones, raising hands, and respecting confidentiality (personal communication, March 30, 2026). This created a safe and organized environment, even in a virtual setting. There were minimal patient management issues. At one point, a participant spoke out of turn, but the facilitator gently redirected them without disrupting the flow of the meeting. This demonstrated strong group management and respect for established norms.
Personally, I found the experience to be meaningful and eye-opening. I was initially unsure how impactful a virtual meeting could be, but I felt a genuine sense of connection and respect for the participants’ honesty. This experience deepened my understanding of recovery as a shared, social process rather than an individual journey. Based on my observations, I would confidently refer future clients to AA. It is an accessible, supportive, and evidence-based resource that can complement formal treatment. While it may not suit everyone, particularly those uncomfortable with its spiritual aspects, it offers a valuable community for many individuals seeking long-term recovery (Kelly et al., 2020).
Reply from David Wallace
Mode 3 Discussion: Motivational Interview with Mary
Motivational interviewing (MI) is a patient-focused, evidence-based counseling method that has proven efficacy for individuals with substance use disorders who exhibit uncertainty regarding behavioral change, as illustrated in Mary's case. Mary’s longstanding alcohol dependence, along with the substantial consequence of her daughter being placed in protective care, underscores the seriousness of her condition and presents a motivating factor for pursuing change. The Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) defines Alcohol Use Disorder (AUD) as a condition characterized by recurrent problematic alcohol consumption that results in impairment or distress. Severity is categorized as mild (2–3 criteria), moderate (4–5 criteria), or severe (6 or more criteria) (American Psychiatric Association, 2022). Mary exhibits persistent difficulties in regulating alcohol consumption, ongoing use despite
adverse outcomes, and significant impairment in parenting responsibilities. These symptoms are most indicative of severe Alcohol Use Disorder (AUD).
The initial phase of Motivational Interviewing (MI) is called engagement, and it involves establishing a therapeutic alliance by demonstrating empathy, employing active listening techniques, and maintaining nonjudgmental communication. When working with Mary, the provider would acknowledge and validate her experiences and feelings in a manner that minimizes conflict. Approaches like asking open-ended questions, offering affirmations, reflecting back what was heard, and summarizing—collectively known as OARS—are effective for building trust (Miller & Rollnick, 2023).
The second step is focusing, which involves the provider working together with others to determine that alcohol use should be the main behavior to address. The provider may carefully examine inconsistencies between Mary's stated values, such as prioritizing active motherhood, and her existing behavioral patterns. This will help the provider and Mary to specifically focus on the main issue at hand, and that will hopefully help alleviate all of the problems that coincide with it. The third step, evoking, entails facilitating "change talk" by guiding Mary to articulate her personal motivations for pursuing change. Inquiries such as, “What concerns do you have regarding your alcohol consumption?” or “How might your life be different if alcohol were not present?” can enhance intrinsic motivation (Magill et al., 2023).
The concluding step is planning, initiated when Mary exhibits readiness. The provider collaborates with her to establish practical objectives, including participation in treatment, implementation of relapse prevention strategies, and enhancement of social support networks. Readiness for change is demonstrated by expressions of willingness, decreased resistance, and language indicating commitment, such as statements like, “I need to stop drinking to regain custody of my daughter.” MI highlights that people become ready for change through supportive dialogue, not by outside force, leading to lasting transformation (Miller & Rollnick, 2023).
In summary, motivational interviewing offers a structured and empathetic approach to resolving Mary's ambivalence about change, while fostering autonomy and enhancing self- efficacy. When the provider leads Mary through engagement, focusing, evoking, and planning, it enables her to see the difference between how much she drinks now and the values she holds as a mother. Using the DSM-5-TR criteria helps clinicians better understand how serious her alcohol use disorder is and highlights why intervention should happen soon. As Mary initiates expressions of change and displays readiness for transformation, the strength of the therapeutic alliance plays a pivotal role in maintaining motivation and supporting sustained recovery over time. In the end, the aim is to decrease Mary’s substance use while enhancing her overall well- being, building her coping abilities, and encouraging reunification with her daughter—all steps that promote a healthier future for both mother and child.
Reply from Merloni Lully
Motivational Interview with Mary
Using the Principles of Motivational Interviewing with Mary
A psychotherapist can apply the principles of motivational interviewing (MI) with Mary, a 27-year-old with several years of history of alcohol use addiction that is adversely affecting her parenting ability. The principles are expressing empathy, highlighting discrepancies, rolling with the client’s resistance, amplifying ambivalence, and supporting self-efficacy (Lauffer et al., 2025; Mercado et al., 2023). To express empathy, the student nurse needs to demonstrate a genuine understanding of Mary’s alcohol dependence/addiction issue and be genuinely concerned with addiction-related experiences, such as the inability to effectively care for her 3-year-old daughter. The student can apply the MI principle of highlighting discrepancies by helping Mary recognize how her alcohol intake behaviors vary with her desire to achieve sobriety, to enable her to get full custody of her daughter, and to enable her to fulfill her parenting roles. Using this MI principle will motivate her to consider change by working towards quitting alcohol. Rolling with discrepancies will need the student nurse to avoid confrontation with Mary about the need to change or her readiness to change, and instead flow with what she wants. Because she is showing ambivalence about her ability to control alcohol intake, applying this principle will enable the student to understand the cause of the mixed feelings about change and work collaboratively with Mary to address it and overcome resistance. To amplify Mary’s ambivalence, the student nurse has to acknowledge that experiencing mixed feelings and feeling uncertain about change is normal and support the patient in overcoming the experienced feelings. According to Lauffer et al. (2025) and Mercado et al. (2023), the MI principle of supporting self-efficacy entails empowering and encouraging a client towards change. The student can use this MI principle by encouraging and guiding Mary through change by walking her through evidence-based alcohol quitting strategies and the most effective strategies to avoid relapse.
A Detailed Overview of How the Interview May Progress
The interview with Mary should align with the four interconnected processes of MI that support addiction clients in exploring motivation and the ability to change. MI follows the interconnected processes of engaging, focusing, evoking, and planning (Mercado et al., 2023). In engaging, the student welcomes Mary, using an open-ended question to inquire about her visit, and actively listens to her to create a safe nurse-patient environment, foster trust, and a healthy therapeutic relationship with her. An example of an open-ended question to Mary is “What brought you to counseling today?” Focusing entails clarifying behavior change objectives and motivations to change. Here, the student should focus on discussing with Mary about the goals to quit alcohol and the desire to gain Kylie’s custody as a motivation to work towards the change. In evoking, the student should intrinsically deduce Mary’s motivation to quit alcohol by offering affirmations, showing reflective listening, asking open-ended questions, and helping her self- explore. For instance, asking her to score her desire to quit alcohol and how alcohol impacts the
kind of mother she aspires to be would elicit intrinsic motivation to quit alcohol. Finally, the student should discuss a plan with Mary on how she will quit alcohol. The plan should specify the appropriate goals, timelines, and strategies.
Ways a Provider Would Recognize that the Patient is Ready to Change
According to Lauffer et al. (2025) and Mercado et al. (2023), readiness to change is noted in a client when there is a shift from expressing ambivalence to showing commitment. A client who is ready to change shows and expresses a desire to do so. For instance, if Mary is ready to quit alcohol, she would use statements such as “I want to quit alcohol,” “my daughter deserves a sober mother,” “I think I can overcome alcoholism,” and “I need to live a sober life.” In these statements, the client expresses a desire to start a new life of sobriety.