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 RecoveryMythsAccording 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 RecoveryMyths 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 RecoveryA 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

#1 12 step recovery should be the foundation of professional treatment.

#2 Practitioners should encourage and assist clients in using 12-step programs, although it is not the basis of the professional counseling.

#3 Practitioners should offer information about 12 step programs to their clients but not encourage or discourage them.

#4 Discussion of 12 step participation has no place in professional treatment.