The Anexo: A New Alcoholics Anonymous-Based Recovery and Prevention Resource in Latino Communities

Introduction: In many U.S. cities with large concentrations of Latino immigrants, the anexo, a variant of Alcoholics Anonymous (AA), provides accessible and affordable recovery services for immigrants with substance use disorders (SUDs). It also provides prevention services for Latino immigrants who are at high risk of developing SUDs. The anexo, with origins in Mexico, is a self-sustaining residential recovery house and AA meeting space where residents may stay for long periods. A structured living arrangement and nightly AA meetings are at the core of the recovery program. Despite their widespread use in Latino immigrant communities, little is known about anexos in the U.S. We are currently conducting a two-year NIDA-funded study on anexos in Northern California. Our main objectives are to understand 1) the help-seeking pathways of Latino immigrants who access anexos; and 2) residents' perceptions of the benefits and drawbacks of this indigenous recovery modality. Methods: We conducted over 180 hours of participant observation at 3 anexos located in urban Northern California. Using purposive sampling, we then conducted semi-structured interviews with 42 anexo residents, 3 directors, and 3 assistant directors. Data analysis was informed by grounded theory. Field notes and interview transcripts were coded using Atlas.ti software. Results: The most common pathway into anexos was direct referral from family and friends. Few were court-mandated to treatment. Although most residents chose anexos because they did not have access to the formal treatment system (due to lack of documentation), several interviewees were U.S. citizens or permanent residents. Women were more likely than men to report accessing the anexos as a prevention resource. According to interviewees, benefits of the anexos included cultural familiarity, use of Spanish language, affordability, ability to work while in treatment, and peer support. Drawbacks included long wait lists, proximity of anexos to high-crime areas, and periodic overcrowding. Conclusions: U.S.-based anexos are a transnational, community-based AA prevention and recovery modality that has undergone significant adaptations to fit the needs of Latino immigrants. Anexos have arisen in response to SUD treatment access barriers encountered by this population. As a bottom-up, culturally indigenous recovery modality that exists to fill a gap in services, anexos merit further study by researchers and clinicians interested in culturally appropriate SUD prevention and treatment.