12 Step Programs

A Brief History of AA  Alcoholics Anonymous  AA was founded in 1935  By 1950 there were 90,000 members  In 1998 there were over 2 million members  100,000 groups in 150 countries (AA)  9% of adults in America have attended an AA Meeting

A Brief History of NA  Narcotics Anonymous  200 registered groups in 1978  20,000 registered groups in 100 countries

Other 12-Step Groups  Alanon  Alateen  Cocaine Anonymous  Nicotine Anonymous  Emotions Anonymous  Overeaters Anonymous

Organization (From the Big Book, 1955)  No alcoholic, man or woman could be excluded from our society  Our leaders might serve but never govern  Each group was to be anonymous and there was to be no professional class of therapy  There were to be no fees or dues

Organization (From the Big Book, 1955)  There was to be the least possible organization, even in our service centers  Our public relations were to be based upon attraction rather than promotion  All members out to be anonymous at the level of press, radio, TV, and films

Organization (From the Big Book, 1955)  Under no circumstances will we give endorsements, make alliances, or enter public controversies

Exercise Generate a list of benefits an addicted client might gain from participation in 12-step recovery program. Generate a list of barriers or problems an addicted client may face in using 12-step recovery as a recovery tool.

Effectiveness  Methodological problems  40-50% who remain active in AA will have several years of sustained abstinence (Emrick)  Increased participation in 12-step practices predicts positive outcomes (Tonigan)

Effectiveness  Attendance at AA was the single best predictor of abstinence in a 10 year follow up study (Cross)  The most effective form of aftercare following treatment (Walsh)  50% of members drop out after 3 months (AA)

Exercise

Deconstructing 12-Step recovery

Deconstructing 12-Step Recovery Myths According to Van Wormer (2004)  AA is coercive  AA is disempowering to minorities and women  AA adheres to the medical model  AA requires total abstinence  AA is a religion/cult

Deconstructing 12-Step Recovery Myths  AA degrades people by constantly forcing them to introduce themselves as an alcoholic  AA meetings are undependable because there is no professional monitoring  AA is just a collection of people telling “drunkalogs”

Deconstructing 12-step Recovery A Narrative Approach “In its simplest form, the narrative approach means understanding life to be experienced as a constructed story. The stories that people tell and are told are powerful forms of communication to both others and one’s self. Stories order experience, give coherence and meaning to events, and provide a sense of history and the future”. Rappoport, 1993

Stories “ A man I met told me if I didn’t think I belonged I should hang around and I would hear my story. Then a few weeks later a woman got up and every word she said I could relate to. Here was this woman with seven or eight years sobriety telling my story”!

Ritual “The center of AA is a ritual event that provides a formalization of the stages of separation and reincorporation and for marking the turning points of person’s lives… forums provide the opportunity for persons to give testimony about the decisions they have made to break from excessive alcohol consumption, to the desires and purposes that motivate these decisions, and to tell and retell the stories of their lives befor a group of witnesses”. Michael White (2000)

Powerlessness  Christian belief holds that “In order to gain your life you must first lose it”.  Buddhists have a koan (a mental puzzle used for meditation) “Giving in is the greatest form of control”.

Powerlessness  Ask clients in a group setting, “if I had one drink, but there is only one, and I offered it to you now, would you take it?  Invite clients to practice moderation by keeping a log of their drinking. They are allowed 3 drinks per day and no more than 1 drink per hour.

Powerlessness To understand powerlessness, stand in the circle of addiction. Look around at the miserable state of affairs most women and men face when they first begin the road to recovery. Am endless cycle of “I will do better tomorrow, and of course I was always drunk that night”.

The Invitation  When you are ready to admit that you have “lost the power of choice in drink” and you have “a desire to stop drinking” you are ready for the fellowship of AA.  Will Power?  Bootstrap Culture  The Power of Community to offer experience, hope, and strength

Metaphor of Disease  Threefold disease mental, physical, and spiritual  The disease controversy is an external controversy  AA members attempt to live a sober life by working a spiritual program that attends to the physical, mental and spiritual needs of the alcoholic who still suffers.

Dependence  A shift in dependence?  In time dependence becomes stewardship.  Sponsorship  Community

Abstinence  Abstinence is achievable “one day at a time”.  Embracing fallibility –“progress is not perfection” –“easy does it”

Higher Power “when they come in, most of their AA group is sober, and they are drunk. Therefore the group is a higher power. That’s a good enough start, and most will progress from there. I know how they fell because I was once that way myself” Bill W.

Higher Power  My soul self  God  The Universe  Buddha  Love  Oneness  The Light  There is something greater than me.

My name is Jill, and I am an alcoholic  I have faced the reality of my dependency and I want to quit.  I have suffered and caused others to suffer just like you.  I am grateful to be an alcoholic because having this condition has led me to a spiritual awakening and to this community

Exercise  Take out you list from the previous exercise. How can we as professional help clients to overcome the barriers and take advantage of the benefits of 12-step recovery?

12-Step Facilitation  What are the key differences between 12 step groups and professional 12 step facilitation?

Other Mutual Support Groups  Women for Sobriety –Certified moderator –Physical disorder like diabetes  SMART Recovery –Cognitive behavioral  Moderation Management

Exercise #112 step recovery should be the foundation of professional treatment. #2Practitioners should encourage and assist clients in using 12-step programs, although it is not the basis of the professional counseling. #3Practitioners should offer information about 12 step programs to their clients but not encourage or discourage them. #4Discussion of 12 step participation has no place in professional treatment.