THE 12 STEP APPROACH TO ALCOHOL ABUSE-DEPENDENCY, AS AN ADJUNCT TO THERAPY AND GENERAL COUNSELLING In our rapidly growing world there are increasing demands on time for traditional client counselling and therapy. Consequently it necessitates therapists finding other methods and tools for helping clients to manage their problems. There are a large number of 12 step programs available that can give this ongoing support and lifelong maintenance. They can assist people to find a spiritual centre from which to grow as individuals and help others.
These 12 step programs can act as a useful tool along with medication, support and treatment when available, helping clients to work towards new significance and achievement in their lives. The original 12-step program, Alcoholics Anonymous (AA) was started in 1935 and has developed to be the most widely used organization for the treatment of alcoholism and substance abuse. There are over 2, 000, 000 members in 134 countries worldwide (Alcoholics Anonymous World Services, 1990).
AA has had a major impact in shaping western society’s view of addiction. The treatment philosophy of AA has changed how many people view themselves, their substance use and abuse, and the roles played by the people around them. The success of AA has led to the establishment of a range of 12-step support groups for other dependencies such as gambling, drug addiction, eating disorders, etc, and for people having problems coping with these people as partners, relatives or friends.
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Hester & Miller (1995) state that with the plethora of self help groups styled on the 12 step model, a practitioner treating a person with an addiction problem would benefit from information to guide the selection of a 12 step group that is most likely to be of benefit to a particular client. As researchers they acknowledge evaluation studies positive findings and benefits of 12-step attendance. AA provides the individual with a setting in which experiences of like-minded people can be shared and trust can be established. Members exchange stories of what is was like, what happened and what it is like now. This allows for identification of the problem, an acknowledgement that a change is needed and what usually promotes this change. It also gives a person listening, hope that they too can make similar positive changes.
The proof of this is seen in the person who is sharing their story. It is not just an hypothetical proposition being put forward by a therapist. AA members are there for their own recognition of a need for support; and at the same time are available for the support of newer and other members who may be experiencing difficulties. All of this support is offered in an unconditional sense, which may be the first time in their life that a person has actually experienced unconditional positive regard. AA meetings are easily accessible; there is no screening of members, the service is free and the only basic requirement for membership is for a “desire to stop drinking.” AA assists in diminishing feelings of isolation (Talbott, 1990).
The idea of assistance in AA originated with it’s founding members Bill Wilson and Bob Smith.
Out of their friendship and support for each other came the AA philosophy that one member can be of aid to another during periods of stress (Kurtz, 1988).
AA provides support to its members in distress by direct support through sponsors. Each member has the opportunity of seeking a “sponsor” member, who is usually some person who has made progress through the program and can offer support and assistance. Sponsors have been found to be a great help in the recovery process, especially in the initial stages. (Fagan, 1986).
Schools are in great need of systems, processes, and personnel who are able to support the needs of students with problem behavior. Research indicates, however, that (while I am a big, fat cheater) information has not been made available to teachers and other professionals in a format that allows these strategies to become common practice. Many teachers choose isolated behavioral strategies that ...
AA supports a model of alcoholism known as a disease model although some members refer to it as a “dis-ease” model.
Throughout the “big-book” of AA (Alcoholics Anonymous, 1976), reference is continually made to alcoholism as being a three-fold disease, physical, mental and spiritual. This is consistent with the World Heath Organisations model of alcoholism as being a bio-psycho-social syndrome. In so doing AA is addressing a holistic – eclectic model of the problem, which allows for its members to see the need for personal acknowledgement and the requirement for change, in all these areas. In addressing the biological / physical aspects of the problem AA states that some people suffer an “allergic reaction to alcohol, in that they process it differently than the rest of the population, and are unable to use the substance in any form. This supports Jellinek’s (1960) disease concept of alcoholism. AA presents alcoholism as a progressive illness that can be arrested but not cured (AAWS, 1984).
This model has unfortunately met with a large number of challengers to its validity by the likes of Erickson, (1992), Miller, (1991) and Peele, (1990, 1992).
These detractors cite lack of scientific evidence and contradictory definitions of what a disease is, as their major premises. In spite of continual challenge from some academic quarters, there is plentiful evidence available in any AA meeting, in any town, worldwide that AA’s view has assisted in reducing the stigma attached to their problem. It has helped reduce feelings of guilt and shame for its members and it has clarified for them the cause of their desire to drink. It moves people away from the concept of “I am a bad person” to “I have a bad problem.” Once this stigma is removed, most people then can concentrate on doing something about their problems. AA’s philosophy includes addressing social, emotional and spiritual elements also.
Kotter’s Eight Step Plan – Orginisational Change Step 1: Create Urgency For change to happen, it helps if the whole company really wants it. Develop a sense of urgency around the need for change. This may help you spark the initial motivation to get things moving. This isn’t simply a matter of showing people poor sales statistics or talking about increased competition. Open an ...
The basis for treatment lies in the 12 steps, which were adapted originally from the Oxford Group, a Christian based organisation. The 12 steps are: 1. We admitted we were powerless over alcohol – that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3.
Made a decision to turn our will and our lives over to the care of God, as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6.
Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8.
Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
(AAWS, 1976) How each of these steps is interpreted and acted upon is up to the individual member. Each 12 step member also has the advantage, when listening to other members speak, of hearing how effective that members own interpretation and action for that step have been for them. In effect the new member has the choice of a various number of proven effective methods at his disposal to choose to replicate, if he wishes to so do. Each of the steps has it’s own unique contribution to therapeutic change. Step 1 is about coming out a denial and the acceptance at depth that there is a problem that needs to be dealt with. It requires an acknowledgement by the member that their attempts at managing their problem have not been successful.
Step 2 is about admitting to the self, the total “insanity” of their entire problem. For example, when looked upon rationally by an outsider, an alcoholics continuing to drink, knowing it causes problems is indeed insane. An AA allegory for this is, that “if a person puts his hand on a hot stove and it gets burned; and he then continues to put his hand back on the stove again after that, then this particular action would indeed be seen as “insane.” So it is for the drinker who continues to drink knowing he has a problem. This step 2 also encourages a seeking for a “higher power” to assist with the problem. This challenges the alcoholic’s self-centred thinking style. It is a cognitive challenge needed for change.
Step 1: Establishing a Sense of Urgency: Help others see the need for change and they will be convinced of the importance of acting immediately. Step 2: Creating the Guiding Coalition: Assemble a group with enough power to lead the change effort, and encourage the group to work as a team. Step 3: Developing a Change Vision: Create a vision to help direct the change effort, and develop strategies ...
Most members initially see that the “power” of the AA group, as a precursor for change, is indeed a powerful force and greater than they themselves as an individual are. As they have not been able to bring about their own change to date. Step 3 is an overt Christian based philosophical tool and is a challenge for most alcoholics who have spent a lifetime with a need for self-control. Previously for most alcoholics’ their God has been their alco h ol – the thing that helps them feel good and helps them cope. This step helps the drinker address the concept of spirituality and also the possibility that he does not have control and does not need so much control in his life to be able to deal with it.
On a purely rational level it has been suggested that 92% of what we think is going to happen, does not occur. Ellis (1975, 1961) states that about 98% of anxiety arises as peoples over-concern for what they think others think about them. This step assists members to put things in their true cognitive and behaviour al perspectives. Step 4 entails making a list of the positive and negative occurrences of their life. It suggests fearlessness in the process. On a cognitive level, this assists in breaking the cycle of denial, justification, rationalization and repression in relation to their life issues.
It is also about balancing the scales to see that there are still some worthy traits at hand. Step 5 is about the spiritual and Christian based philosophy of confession. By speaking to another person, who listens and does not scold or berate them for their actions allows people to put their judgement’s of own their life into true perspectives. Addicts tend to think in extremes and either over emphasise problems or be totally dismissive of them.
"Thus conscience does make cowards of us all" - William Shakespeare. Is it true? Does the conscience actually regulate our behaviour and make us timid and humble as Shakespeare suggests? Does the conscience have the power to make cowards of us? Or would it not be able to prevent us from becoming tyrants? More importantly, does the conscience actually exist? The Oxford Dictionary defines ' ...
As Melody (1989) states, “it helps addicts take the stink out of their shit.” Their history is still there but it doesn’t have the gut wrenching guilt and remorse that it previously held with overemphasis at a cognitive level. Step 6 is a truly spiritual step. It is also a rational step in that it allows the addict to be aware that he has defects of character, as do all humans, and they the removal of some of these defects make take some time. Again this assists the clients and the counselling process, as the desire for immediate change is brought back to a realistic perspective.
Step 7 deals with shortcomings, which can be simply translated as not having done some things that were needed to be done at the time. This may be seen as the opposite of character defects. It also addressed a quality that is quite new for addicts. It speaks about humility, which a lot of addicts do not seem to possess. In the Twelve Steps and Traditions (AAWS, 1998) it is suggested that without some degree of humility, no alcoholic can stay sober at all. Again this step is also about letting go of self-reliance, and turning outside of the self for assistance and letting go of a lifetime of self-centered ness.
Step 8 helps the addict to start to repair relationships. They are encouraged to make a list of people harmed, seek out where they themselves were at fault, and then make a vigorous attempt to repair this damage. This challenges the social, cognitive and behaviour al imbalances at the core of the addict’s lifestyle. By the practice of this step, it again helps the recovered addict to no longer think in extremes, either about his behaviour or the behaviour of others. It assists with moderation. Step 9 discusses making amends to people on the list, but also stresses good judgement and timing.
It is about clearing out the wreckage of the past and taking responsibility. This step also suggests that making an amend does not necessarily mean approaching people when dragging up old hurts may be injurious to them. This step is again about moderation and social repair. Step 10 is about getting on with life on a more practical, structured way.
It suggests continually taking inventory of life’s problems and promptly facing up to it in a mature responsible way, that eliminates anxiety and worry quickly. Step 11 is another step about getting on with life in a more relaxed, peaceful calm way. Using techniques that are new to the addict to assist in his cognitive and behaviour al and spiritual well being. It is about prayer and meditation and recognition of the need for this in mankind for a truly peaceful and relaxed existence. The step is about personal comfort, strength, belonging and connection. Step 12 is about the recovered addict helping his fellow man; which is a spiritual and Christian tradition.
Describe the benefits of encouraging and rewarding children’s positive behaviour. It is a necessity for a care provider to reward positive behaviour as positive reinforcement is vital for a child’s development. If you only punish a child for negative behaviour and not rewarding positive behaviour as well it will make the child develop a distort view of cause and affect, leaving them unsure of what ...
The practical application of this step for the recovered addict is that by helping others he re-enforces his own recovery by being able to objectively see where he has moved along the recovery continuum. On this level it also allows him to see where he does not want to go back to, and also that he has put a number of very positive changes into his own life. All of these steps address issues that need to be addressed in the counselling and therapy sphere with clients in recovery. By attending 12 step meetings and gaining strong support and freedom from isolation clients have another tool available to them in their quest for change. The great advantage here is that the financial cost to the client is zero (except for maybe putting a dollar into the tin at the end of the meeting to help buy the coffee) In her book Adult Children of Alcoholics, Janet Woititz (1983) strongly advocates 12 steps groups as an adjunct to therapy for people recovering from addiction or people that have been associated with these problems.
Her research indicated a need in this area to help people to be able to live a healthy lifestyle, where they are responsible for their own behaviour and learn how to make healthy choices. Pita (1995) states that AA and RET have the same basic philosophy, apart from the spirituality. She goes on to state that both 12 step programs and Cognitive Behavioural Therapy have an essentially behaviour al component. She states that in AA you hear someone talking about “talking but not walking the program” and “needing to do the legwork.” This indicates a need for behaviour al change.
She suggests that both approaches require some behaviour al changes as proof of philosophical change. She does however favour the AA model because of its spiritual base and recognition of spirituality as a dimension of our being furtherance of our experience of life. Kurtz (1981) puts the effectiveness of AA down to people’s ability to deal with shame Through the 12 step process. He states that is why so many other therapies, far removed from alcoholism, such as obesity, grief and certain deforming diseases, for example build their programs on AA’s 12 steps.
He finds that the whole self-help mutual-aid movement owes it’s philosophy and most of it’s modalities to alcoholics anonymous. He recommends AA as a positive aid for clients and philosophically suggests AA’s acknowledgement of both limited control and limited dependence, plus the need to embrace each, is necessary to the attainment of its apparent opposite. Martin (1966) offered some wise information on AA and the health professions. He stated that not all professionals accepted AA without question and that not all alcoholics that get sober and stay sober do so with the help of AA. However he did say that what works best for most people was AA and that nothing succeeds like success. Martin indicated that his research into the disease model concept shows it as the most valid.
As a practising priest and therapist he strongly advocated the use of AA to professionals as an assistance tool for their clients. He informs his reader that an educated person is one who has learned to say that “I don’t know; I don’t have all the answers.” He went on to say that the field of alcoholism and addictions needs people willing to take that approach. That is, acknowledging that we don’t have all the answers but accepting that we have enough to be able to help the alcoholic or addict and to be able to take what we do know and put it to work. Twelve step programs have long stressed the significance of spiritual practices. It is through the replacement of distress, shame and addiction with a new found spirituality that these programs have been so successful. It is readily apparent that the 12-step movement has a lot to offer clients and therapists in the counselling process.
REFERENCES Alcoholics Anonymous World Services, Inc, 1976, (3 rd Edn) Alcoholics Anonymous, New York: Alcoholics Anonymous World Services, Inc. Alcoholics Anonymous World Services, Inc, 1988, Twelve Steps and Twelve Traditions, New York: Alcoholics Anonymous World Services, Inc Kurtz, E. , 1981, Shame & Guilt, New York: Hazel den. Jellinek, E. M.
, 1960, The Disease Concept of Alcoholism, New York: Hill house Press Martin, J. C. , 1982, No Laughing Matter, Chalk talks on Alcohol, New York: Harper and Rowe. Melody, Pia, 1989, Facing Co dependence, NEW York: Harper Collins. Pita, D. D.
, 1995, Addictions Counselling, New York: The Crossroads Publishing Company. Reid, K. H. , and Miller, W. R. , 1995, Handbook of Alcoholism Treatment Approaches, Effective Alternatives (2 nd Edn), Boston: Allyn and BaconWoititz, J.
, 1983, Adult Children of Alcoholics, Florida: Health Communications Inc.