1 12-Step Traditions, The Disease Concept, and Group Psychotherapy Integrations Chapter 3 and 5 in Flores

Step History and Foundations Ideologies spawned from Christian religious sect “Oxford Group” Temperance movement ideas and concepts Connection to and between struggling alcoholics (Bill Wilson / Dr. Robert Smith) Founded June Conversation with Carl Jung Bill’s Spiritual Awakening...

3 Bill W. Reports: Lying there in conflict, I dropped into the blackest depression I had ever known. Momentarily my prideful depression was crushed. I cried out, "Now I am ready to do anything - anything to receive what my friend Ebby has." Though I certainly didn't expect anything, I did make this frantic appeal, "If there be a God, will He show Himself!" The result was instant, electric beyond description. The place seemed to light up, blinding white. I knew only ecstasy and seemed on a mountain. A great wind blew, enveloping and penetrating me. To me, it was not of air but of Spirit. Blazing, there came the tremendous thought, "you are a free man." Then the ecstasy subsided. Still on the bed, I now found myself in a new world of consciousness which was suffused by a Presence. One with the Universe, a great peace came over me.

4 I thought, "So this is the God of the preachers, this is the great Reality." But soon my so-called reason returned, my modern education took over and I thought I must be crazy and I became terribly frightened. Dr. Silkworth, a medical saint if ever there was one, came in to hear my trembling account of this phenomenon. After questioning me carefully, he assured me that I was not mad and that perhaps I had undergone a psychic experience which might solve my problem. Skeptical man of science though he then was, this was most kind and astute. If he had of said, "hallucination," I might now be dead. To him I shall ever be eternally grateful. Good fortune pursued me. Ebby brought me a book entitled "Varieties of Religious Experience" and I devoured it. Written by William James, the psychologist, it suggests that the conversion experience can have objective reality. Conversion does alter motivation and it does semi-automatically enable a person to be and to do the formerly impossible. Significant it was, that marked conversion experience came mostly to individuals who knew complete defeat in a controlling area of life. The book certainly showed variety but whether these experiences were bright or dim, cataclysmic or gradual, theological or intellectual in bearing, such conversions did have a common denominator - they did change utterly defeated people. Bill continues...

Disease Perspective: Primary Keys Addiction to chemicals or behaviors or processes is not a symptom of a more serious core issue Primary condition that must be arrested if any progress in treatment is to occur AA holds total abstinence as key

The Field is Merging Academic perspective Disease practitioners Sharing of evidence The legitimization of dual disorders The question of controlled drinking?

Specific Implications of Group Therapy & the Disease Model Beginning of treatment is not aimed at uncovering psychological pathology, but at identifying the defenses and characterological deficits that prevent compliance with abstinence and recovery Relieving or discovering underlying symptom will not bring about recovery or abstinence Disease can be viewed as a lifestyle of behaviors Characterization of “oneself as an alcoholic” AA doesn’t so much teach us how to handle our drinking but how to handle our sobriety Folks in AA don’t go for knowledge they go for inspiration They need to be emotionally touched

An A.A. Briefing ❖ Most frequently consulted source for help with drinking problems ❖ Approx. 1 in every 10 adults in the US has attended an AA meeting ❖ 2/3 of these have attended ONE meeting because of another person’s drinking ❖ Empirical evidence on 12-steps efficacy is sparse and inconclusive

Membership Stats ❖ Currently there are 97,000 groups spread over 150 countries with a total membership estimated at 2 million ❖ 1.2 million of these are from the U.S. and Canada ❖ As of Jan Canada reportedly had 110,449 members in AA (General Service Office of AA, 2007). ❖ Non for profit group

Primary Purpose ? ❖ Provide its members with a program for ‘living” without chemicals / behaviours ❖ Carry message to other addicts who still suffer - there is a way to sobriety! ❖ This all done with a language an addict understands ❖ BECAUSE AN ADDICT IS TALKING TO ANOTHER ADDICT

How it works? ❖ “Mirroring” break thru defenses ❖ See through preoccupation with the “self” ❖ Spiritual growth includes self - but learn to be apart of... ❖ Seeing the “one as whole” ❖ Offered a choice: New life or Old life

Here’s the Kicker ❖ Requires active participation! ❖ Not passive attendance ❖ You have to work the program ❖ Accept you are powerless and your life has become unmanageable

The Bottom Line ❖ Stop looking for a cause and take responsibility for your actions ❖ Come to see that YOU ARE YOUR PROBLEM - not the drug of choice or behavior ❖ Lifelong process

How it works (cont.) ❖ Challenges and usurps, ❖ Loneliness ❖ Uniqueness ❖ Provides and offers ❖ Distillation of Hope ❖ Predictability

More How About it Works Later in the Lecture

The 12 Steps of Alcoholics Anonymous

Step 1 - We admitted we powerless over alcohol that our lives had become unmanageable Step 2 - Came to believe that a Power greater than ourselves could restore us to sanity Step 3 - Made a decision to turn our will and our lives over to the care of God as we understood him Step 4 - Made a searching and fearless moral inventory of ourselves Step 5 - Admitted to God, to ourselves, and to another human being the exact nature of our wrongs Step 6 - Were entirely ready to have God remove all these defects of character Step 7 - Humbly asked Him to remove our shortcomings Step 8 - Made a list of all persons we had harmed, and became willing to make amends to them all 12 STEPS OF ALCOHOLIC ANONYMOUS

Step 9 - Made direct amends to such people wherever possible, except when to do so would injure them or others Step 10 - Continued to take personal inventory and when we were wrong promptly admitted it Step 11 - Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God's will for us and the power to carry that out Step 12 - Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs

19 More Metaphoric Disease as metaphor more than scientific disease More clinically relevant

20 Is abstinence necessary? Heavy drinkers might not be alcoholic! Controlled drinking?

21 Controlled drinking camps Critically important to distinguish the diseased from the abusers One defines an addict “Pickle can’t become a cucumber again”

22 Heavy drinker’s who may not be alcoholic Display less severe physical dependence Tend to be younger Tend to not have positive family history of addiction

23 Low bottom, high bottom High bottom (airline pilots, neurosurgeons, veterinarians, attorneys, nurses, priests) Function responsibly in their demanding careers (eventually may crash) Degree of social consequences before recovery and after abstinence may have not brought about severe social consequences Still considered alcoholics Diagnose yourself (admit powerlessness and unmanageability)

24 An Example of a High Bottom

25 Valliant’s deviance and social consequences as diagnostic criterion Believes deviance and social consequence more reliable that loss of control Put 10 alcoholics in a room and tell them that research shows that 1 out 10 people can return to normal drinking... Each of those 10 will think they are SPECIAL ONE

26 Jerome Frank: Anthropological Perspective AA has always know that group affiliation can counteract isolation and demoralization... This is for you cell phone addicts

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28 Specific Implications of Group and the Disease Concept Chronic diseases require constant monitoring For the addict this means monitoring of lifestyle Alcoholism cessated never cured Beginning group psychotherapy is not so much about uncovering psychological pathology as it’s about identifying defenses that prevent abstinence and recovery

29 What is the defense here?

30 Exotic beliefs and useful illusions Blowing out the flame of desire NIRVANA AND SAMSARA ARE ONE

31 Why it works? Program will not work with those who only want to quit, or want to quit because they are afraid of losing their families or jobs Desire based on enlightened self-interest Back to step 1 - illness is an uncontrollable drinking problem - even one drink is too many

32 Surrender Gut level, surrender to power greater than oneself Confront naked existence Haven’t be able to manage part of life affected by their drinking Cannot do anything about tomorrow All have quit for 24 hours, a few days, a week, a month... Constant state of staying sober (back to useful illusions)